Provider Demographics
NPI:1831193259
Name:ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY, INC.
Entity type:Organization
Organization Name:ALCOHOLISM AND DRUG SERVICES OF LOWER LUZERNE COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CAC
Authorized Official - Phone:570-455-9902
Mailing Address - Street 1:145 W BROAD ST
Mailing Address - Street 2:FL 2
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6500
Mailing Address - Country:US
Mailing Address - Phone:570-455-9902
Mailing Address - Fax:570-455-9452
Practice Address - Street 1:145 W BROAD ST
Practice Address - Street 2:FL 2
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6500
Practice Address - Country:US
Practice Address - Phone:570-455-9902
Practice Address - Fax:570-455-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402249251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable