Provider Demographics
NPI:1861846438
Name:FAYETTE TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:FAYETTE TREATMENT CENTER, LLC
Other - Org Name:GREENE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-880-5335
Mailing Address - Street 1:2695 E ROY FURMAN HWY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAELS
Mailing Address - State:PA
Mailing Address - Zip Code:15320-2434
Mailing Address - Country:US
Mailing Address - Phone:724-966-2044
Mailing Address - Fax:
Practice Address - Street 1:2695 E ROY FURMAN HWY
Practice Address - Street 2:
Practice Address - City:CARMICHAELS
Practice Address - State:PA
Practice Address - Zip Code:15320-2434
Practice Address - Country:US
Practice Address - Phone:724-966-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
PA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone