Provider Demographics
NPI:1871041558
Name:PTEST LLC
Entity Type:Organization
Organization Name:PTEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-760-0572
Mailing Address - Street 1:53 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-4239
Mailing Address - Country:US
Mailing Address - Phone:570-760-0572
Mailing Address - Fax:
Practice Address - Street 1:162 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3402
Practice Address - Country:US
Practice Address - Phone:570-760-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility