Provider Demographics
NPI:1780100453
Name:FIRETREE, LTD.
Entity type:Organization
Organization Name:FIRETREE, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DESANTO
Authorized Official - Suffix:
Authorized Official - Credentials:LSW CCDP-D
Authorized Official - Phone:570-601-0877
Mailing Address - Street 1:800 WEST FOURTH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5895
Mailing Address - Country:US
Mailing Address - Phone:570-601-0877
Mailing Address - Fax:570-326-1050
Practice Address - Street 1:2275 WARREN ROAD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2444
Practice Address - Country:US
Practice Address - Phone:724-471-1254
Practice Address - Fax:724-471-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA327030251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health