Provider Demographics
NPI:1801022827
Name:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Other - Org Name:CHOICES PROGRAM OF WYOMING VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:562 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3721
Mailing Address - Country:US
Mailing Address - Phone:570-552-3900
Mailing Address - Fax:570-552-3907
Practice Address - Street 1:307 LAIRD ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6915
Practice Address - Country:US
Practice Address - Phone:570-552-6000
Practice Address - Fax:570-552-6020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-04
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA407052261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022885770008Medicaid