Provider Demographics
NPI:1366609646
Name:CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Entity type:Organization
Organization Name:CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TECONCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-817-1400
Mailing Address - Street 1:800 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3278
Mailing Address - Country:US
Mailing Address - Phone:814-817-1400
Mailing Address - Fax:814-817-1447
Practice Address - Street 1:1885 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1227
Practice Address - Country:US
Practice Address - Phone:814-817-1400
Practice Address - Fax:814-817-1447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOME OF BRADFORD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007710210084Medicaid
PA1007710210088Medicaid
PA1007710210114Medicaid
PA1007710210057Medicaid
PA1007710210071Medicaid
PA1007710210079Medicaid
PA1007710210081Medicaid
PA1007710210083Medicaid
PA1007710210087Medicaid
PA1007710210075Medicaid
PA1007710210092Medicaid
PA1007710210108Medicaid
PA1007710210076Medicaid