Provider Demographics
NPI:1982182507
Name:TEEN CHALLENGE TRAINING CENTER, INC
Entity Type:Organization
Organization Name:TEEN CHALLENGE TRAINING CENTER, INC
Other - Org Name:PENNSYLVANIA ADULT & TEEN CHALLENGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-933-2804
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:REHRERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19550-0098
Mailing Address - Country:US
Mailing Address - Phone:717-933-4181
Mailing Address - Fax:
Practice Address - Street 1:33 TEEN CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:REHRERSBURG
Practice Address - State:PA
Practice Address - Zip Code:19550-5000
Practice Address - Country:US
Practice Address - Phone:717-933-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEEN CHALLENGE TRAINING CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA062579261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder