Provider Demographics
NPI:1780218594
Name:DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, INC.
Entity Type:Organization
Organization Name:DAVIS ARCHWAY CENTERS FOR ADDICTION TREATMENT, INC.
Other - Org Name:DAVIS ARCHWAY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:724-867-0202
Mailing Address - Street 1:114 COURSON LN
Mailing Address - Street 2:
Mailing Address - City:EMLENTON
Mailing Address - State:PA
Mailing Address - Zip Code:16373-2502
Mailing Address - Country:US
Mailing Address - Phone:724-867-0202
Mailing Address - Fax:724-867-0202
Practice Address - Street 1:114 COURSON LN
Practice Address - Street 2:
Practice Address - City:EMLENTON
Practice Address - State:PA
Practice Address - Zip Code:16373-2502
Practice Address - Country:US
Practice Address - Phone:724-867-0202
Practice Address - Fax:724-867-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024600580002Medicaid
PA107112OtherPENNSYLVANIA DEPARTMENT OF DRUG AND ALCOHOL PROGRAMS