Provider Demographics
NPI:1740438944
Name:NORTHEAST TREATMENT CENTER, INC
Entity type:Organization
Organization Name:NORTHEAST TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
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:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104870251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE273261OtherMANAGEG HEALTH NETWORK
DE159997OtherBLUE CROSS OF DELWARE
PA1000838OtherCOMMUNITY BEHAVIORAL HEALTH
PA311749OtherMAGELLAN - KEYSTONE HEALTH PLAN EAST
DE1000022246OtherDIAMOND STATE PARTNERS
PA100773572Medicaid
DE217465OtherUNISON HEALTH PLAN
PA296503000OtherMAGELLAN HEALTH CHOICES DELAWARE CTY
PA0004972000OtherMAGELLAN - PERSONAL CHOICE
PA462315000OtherMAGELLAN HEALTH CHOICES BUCKS/MONTGOMERY CTY'S
DE100022246Medicaid
PA046410000OtherMAGELLAN - COMMERCIAL