Provider Demographics
NPI:1851344527
Name:DIVERSIFIED TREATMENT ALTERNATIVES
Entity Type:Organization
Organization Name:DIVERSIFIED TREATMENT ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA MED
Authorized Official - Phone:570-524-9986
Mailing Address - Street 1:148 FAIRFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837
Mailing Address - Country:US
Mailing Address - Phone:570-524-9986
Mailing Address - Fax:570-524-9973
Practice Address - Street 1:148 FAIRFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-524-9986
Practice Address - Fax:570-524-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA348770322D00000X
PA301960322D00000X
PA308000385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered385H00000XRespite Care FacilityRespite Care