Provider Demographics
NPI:1578829255
Name:CONCERN PROFESSIONAL SERVICES FOR CHILDREN, YOUTH, & FAMILIES
Entity Type:Organization
Organization Name:CONCERN PROFESSIONAL SERVICES FOR CHILDREN, YOUTH, & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-944-0445
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:610-944-0445
Mailing Address - Fax:610-944-8834
Practice Address - Street 1:1873 SHUMWAY HILL RD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6840
Practice Address - Country:US
Practice Address - Phone:570-724-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA222440261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100006375Medicaid