Provider Demographics
NPI:1497258347
Name:TEEN CHALLENGE TRAINING CENTER, INC
Entity Type:Organization
Organization Name:TEEN CHALLENGE TRAINING CENTER, INC
Other - Org Name:PENNSYLVANIA ADULT AND TEEN CHALLENGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-933-2804
Mailing Address - Street 1:33 TEEN CHALLENGE RD
Mailing Address - Street 2:
Mailing Address - City:REHRERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19550-5000
Mailing Address - Country:US
Mailing Address - Phone:717-933-2804
Mailing Address - Fax:
Practice Address - Street 1:220 CHALLENGE LN
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-2417
Practice Address - Country:US
Practice Address - Phone:724-265-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEEN CHALLENGE TRAINING CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA707087324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031499800002Medicaid