Provider Demographics
NPI:1780050690
Name:CARBON COUNTY
Entity type:Organization
Organization Name:CARBON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AAA ADMININISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-824-7830
Mailing Address - Street 1:401 DELAWARE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1946
Mailing Address - Country:US
Mailing Address - Phone:610-824-7830
Mailing Address - Fax:610-824-7836
Practice Address - Street 1:401 DELAWARE AVE FL 3
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1946
Practice Address - Country:US
Practice Address - Phone:610-824-7830
Practice Address - Fax:610-824-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007600550004Medicaid