Provider Demographics
NPI:1740780279
Name:WILKES BARRE TREATMENT LLC
Entity Type:Organization
Organization Name:WILKES BARRE TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-7705
Mailing Address - Street 1:225 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4319
Mailing Address - Country:US
Mailing Address - Phone:954-533-7705
Mailing Address - Fax:954-781-7173
Practice Address - Street 1:1100 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:LAUREL RUN
Practice Address - State:PA
Practice Address - Zip Code:18706-9520
Practice Address - Country:US
Practice Address - Phone:954-533-7705
Practice Address - Fax:954-781-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X
PA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA407068OtherSTATE LICENSE