Provider Demographics
NPI:1619131927
Name:CEN CLEAR CHILD SERVICES INC
Entity Type:Organization
Organization Name:CEN CLEAR CHILD SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-342-5678
Mailing Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-8112
Mailing Address - Country:US
Mailing Address - Phone:814-342-5678
Mailing Address - Fax:814-342-2755
Practice Address - Street 1:580 OLD ROUTE 322
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866
Practice Address - Country:US
Practice Address - Phone:814-342-5678
Practice Address - Fax:814-342-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA406200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100005322Medicaid