Provider Demographics
NPI:1851442586
Name:ADVANCED COMMUNITY SERVICE ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED COMMUNITY SERVICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-348-6100
Mailing Address - Street 1:1141 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-207-7919
Practice Address - Fax:570-963-1953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRANTON COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007706410012Medicaid
PA866441Medicare PIN