Provider Demographics
NPI:1922207257
Name:TRI COUNTY HUMAN SERVICES CENTER INC
Entity Type:Organization
Organization Name:TRI COUNTY HUMAN SERVICES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-1732
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:185 FALLBROOK ST
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0514
Mailing Address - Country:US
Mailing Address - Phone:570-282-1732
Mailing Address - Fax:570-282-6808
Practice Address - Street 1:614 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1821
Practice Address - Country:US
Practice Address - Phone:570-253-0321
Practice Address - Fax:570-253-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001889Medicaid
PA100001889Medicaid
059746Medicare PIN