Provider Demographics
NPI:1649515552
Name:NULTON DIAGNOSTIC & TREATMENT CENTER, PC.
Entity type:Organization
Organization Name:NULTON DIAGNOSTIC & TREATMENT CENTER, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIESHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-262-0025
Mailing Address - Street 1:214 COLLEGE PARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:814-266-8745
Practice Address - Street 1:110 FRANKLIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:814-410-2106
Practice Address - Fax:814-410-2108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NULTON DIAGNOSTIC AND TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-04
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA330020251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health