Provider Demographics
NPI:1417017096
Name:ALCOHOL AND DRUG ABUSE SERVICES INC
Entity Type:Organization
Organization Name:ALCOHOL AND DRUG ABUSE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:814-642-2910
Mailing Address - Street 1:120 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1251
Mailing Address - Country:US
Mailing Address - Phone:814-642-9541
Mailing Address - Fax:814-642-9596
Practice Address - Street 1:120 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1251
Practice Address - Country:US
Practice Address - Phone:814-642-9541
Practice Address - Fax:814-642-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-11-03
Deactivation Date:2007-04-06
Deactivation Code:
Reactivation Date:2008-02-27
Provider Licenses
StateLicense IDTaxonomies
PA427024324500000X
PA427033324500000X
PA427038324500000X
PA427034324500000X
PA127037324500000X
PA537034324500000X
PA241094324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007395340012Medicaid
PA1007395340018Medicaid
PA1007395340006Medicaid
PA1007395340007Medicaid
PA1007395340019Medicaid
PA1007395340016Medicaid
PA1007395340015Medicaid
PA1007395340015Medicaid