Provider Demographics
NPI:1689740839
Name:FAMILY CARE FOR CHILDREN & YOUTH, INC.
Entity Type:Organization
Organization Name:FAMILY CARE FOR CHILDREN & YOUTH, INC.
Other - Org Name:FAMILY BEHAVIORAL HEALTH PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:STORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-522-9790
Mailing Address - Street 1:25 BELFORD BLVD.
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-9701
Mailing Address - Country:US
Mailing Address - Phone:570-522-9790
Mailing Address - Fax:570-522-0016
Practice Address - Street 1:160 ROOSEVELT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-3378
Practice Address - Country:US
Practice Address - Phone:717-846-3909
Practice Address - Fax:717-846-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA311050261QM0801X, 261QM0850X, 261QM0855X
PA212580320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001317940019Medicaid
PA1001317940004Medicaid
PA1001317940004Medicaid
PA033092Medicare ID - Type Unspecified