Provider Demographics
NPI:1740467976
Name:ELLEN OBRIEN GAISER ADDICTION CENTER
Entity type:Organization
Organization Name:ELLEN OBRIEN GAISER ADDICTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRANIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:724-287-8205
Mailing Address - Street 1:315 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5803
Mailing Address - Country:US
Mailing Address - Phone:724-256-8882
Mailing Address - Fax:724-256-8879
Practice Address - Street 1:315 LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-0000
Practice Address - Country:US
Practice Address - Phone:724-256-8882
Practice Address - Fax:724-256-8879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLEN OBRIEN GAISER ADDICTION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA107025101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01116440Medicaid
PA01724720Medicaid