Provider Demographics
NPI: | 1922553429 |
---|---|
Name: | ACADIA HEALTHCARE |
Entity Type: | Organization |
Organization Name: | ACADIA HEALTHCARE |
Other - Org Name: | DISCOVERY HOUSE |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | COUNSELOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MATTHEW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KIMBLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 717-233-7290 |
Mailing Address - Street 1: | 99 S CAMERON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HARRISBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17101-2809 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 99 S CAMERON ST |
Practice Address - Street 2: | |
Practice Address - City: | HARRISBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17101-2809 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-233-7290 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ACADIA HEALTHCARE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2016-08-25 |
Last Update Date: | 2016-08-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | RC0181901 | 261QM2800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone |