Provider Demographics
NPI:1417578881
Name:COMMISSION ON ECONOMIC OPPORTUNITY
Entity Type:Organization
Organization Name:COMMISSION ON ECONOMIC OPPORTUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-826-0510
Mailing Address - Street 1:P.O. BOX 1127
Mailing Address - Street 2:165 AMBER LANE
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18703-1127
Mailing Address - Country:US
Mailing Address - Phone:570-826-0510
Mailing Address - Fax:570-829-1665
Practice Address - Street 1:165 AMBER LANE
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-1127
Practice Address - Country:US
Practice Address - Phone:570-826-0510
Practice Address - Fax:570-829-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001679705Medicaid