Provider Demographics
NPI:1609889351
Name:PATHWAY TO RECOVERY COUNSELING AND EDUCATIONAL SERVICES
Entity Type:Organization
Organization Name:PATHWAY TO RECOVERY COUNSELING AND EDUCATIONAL SERVICES
Other - Org Name:ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FENO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-455-9902
Mailing Address - Street 1:223 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6201
Mailing Address - Country:US
Mailing Address - Phone:570-455-9902
Mailing Address - Fax:570-455-9452
Practice Address - Street 1:223 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6201
Practice Address - Country:US
Practice Address - Phone:570-455-9902
Practice Address - Fax:570-455-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PA226200251K00000X, 251S00000X, 261Q00000X, 261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005442270002Medicaid