Provider Demographics
NPI:1750854790
Name:NORTHEAST TREATMENT CENTERS, INC
Entity Type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7015
Mailing Address - Street 1:7520 STATE RD STE D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3411
Mailing Address - Country:US
Mailing Address - Phone:215-451-7015
Mailing Address - Fax:215-708-9480
Practice Address - Street 1:154 E HUNTINGDON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1030
Practice Address - Country:US
Practice Address - Phone:215-739-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST TREATMENT CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100773572Medicaid