Provider Demographics
NPI:1639394240
Name:CLEARFIELD JEFFERSON DRUG AND ALCOHOL COMMISSION
Entity Type:Organization
Organization Name:CLEARFIELD JEFFERSON DRUG AND ALCOHOL COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-371-9002
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:FALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15840-0647
Mailing Address - Country:US
Mailing Address - Phone:814-371-9002
Mailing Address - Fax:814-371-9055
Practice Address - Street 1:104 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:15840-0647
Practice Address - Country:US
Practice Address - Phone:814-371-9002
Practice Address - Fax:814-371-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101835590 0002Medicaid