Provider Demographics
NPI:1942506514
Name:MINSEC COMPANIES, LLC
Entity Type:Organization
Organization Name:MINSEC COMPANIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCBT,CCJP,CCDP
Authorized Official - Phone:610-892-9167
Mailing Address - Street 1:101 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6107
Mailing Address - Country:US
Mailing Address - Phone:610-892-9167
Mailing Address - Fax:610-892-9166
Practice Address - Street 1:145 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6317
Practice Address - Country:US
Practice Address - Phone:570-459-1748
Practice Address - Fax:570-489-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA407056324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility