Provider Demographics
NPI:1295915296
Name:SUSQUEHANNA COUNTY DRUG AND ALCOHOL COMMISSION
Entity type:Organization
Organization Name:SUSQUEHANNA COUNTY DRUG AND ALCOHOL COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEMANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALESKY
Authorized Official - Suffix:
Authorized Official - Credentials:CAAP
Authorized Official - Phone:570-278-7101
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-0047
Mailing Address - Country:US
Mailing Address - Phone:570-278-7101
Mailing Address - Fax:570-278-2995
Practice Address - Street 1:7 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-1032
Practice Address - Country:US
Practice Address - Phone:570-278-7101
Practice Address - Fax:570-278-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management