Provider Demographics
NPI:1720102569
Name:NORTHEAST TREATMENT CENTERS, INC
Entity Type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS, INC
Other - Org Name:NORTHEAST TREATMENT CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7159
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4005
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-925-6897
Practice Address - Street 1:499 N 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4005
Practice Address - Country:US
Practice Address - Phone:215-451-7000
Practice Address - Fax:215-925-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA910194251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022246Medicaid
PA0004972000OtherPERSONAL CHOICE
PA296503000Medicaid
PA1007738860039Medicaid
DE100022246Medicaid
DE159997OtherBLUE CROSS OF DELAWARE
DEMAGELLANOther04641000
PA462315000Medicaid
PAMAGELLANOther046410000
PA1007738860040Medicaid
DE273261OtherMANAGED HEALTH NETWORK
PA311749OtherKEYSTONE HEALTH PLAN EAST