Provider Demographics
NPI:1477789287
Name:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Other - Org Name:COMMUNITY COUSENLING SERVICE OF NE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:562 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3721
Mailing Address - Country:US
Mailing Address - Phone:570-552-3700
Mailing Address - Fax:570-552-3733
Practice Address - Street 1:562 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3721
Practice Address - Country:US
Practice Address - Phone:570-823-0070
Practice Address - Fax:570-823-0123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA222930251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022885770016Medicaid