Provider Demographics
NPI:1336395607
Name:BRADFORD COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:BRADFORD COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-1760
Mailing Address - Street 1:220 MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1822
Mailing Address - Country:US
Mailing Address - Phone:570-265-1760
Mailing Address - Fax:570-265-8541
Practice Address - Street 1:220 MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1822
Practice Address - Country:US
Practice Address - Phone:570-265-1760
Practice Address - Fax:570-265-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007780690003OtherEARLY INTERVENTION SERVICES