Provider Demographics
NPI:1598907768
Name:NORTHUMBERLAND COUNTY MH TCM
Entity Type:Organization
Organization Name:NORTHUMBERLAND COUNTY MH TCM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MH/MR ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-495-2002
Mailing Address - Street 1:217 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2205
Mailing Address - Country:US
Mailing Address - Phone:570-495-2002
Mailing Address - Fax:570-495-2498
Practice Address - Street 1:217 N CENTER ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2205
Practice Address - Country:US
Practice Address - Phone:570-495-2002
Practice Address - Fax:570-495-2498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHUMBERLAND COUNTY MH/MR AND DRUG & ALCOHOL PROGRAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management