Provider Demographics
NPI:1013982008
Name:DRUG AND ALCOHOL TREATMENT SERV
Entity Type:Organization
Organization Name:DRUG AND ALCOHOL TREATMENT SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-344-3877
Mailing Address - Street 1:116 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1800
Mailing Address - Country:US
Mailing Address - Phone:570-961-1997
Mailing Address - Fax:570-344-9632
Practice Address - Street 1:441 WYOMING AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1800
Practice Address - Country:US
Practice Address - Phone:570-344-3877
Practice Address - Fax:570-344-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA999022OtherBCBS ID #
PA90006OtherGEISINGER HEALTH ID#
PA093511OtherFPH ID #
PA1007465840002Medicaid
PA4544717OtherAETNA ID#
PW=========OtherTAX ID #