# GLADE RUN LUTHERAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225193030
- **Authorized official:** DR. CHARLES T. LOCKWOOD (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (724) 452-4453

## Contact information

- **Practice address:** BEAVER ROAD, ZELIENOPLE, PA 16063-0070
- **Practice address phone:** (724) 452-4453
- **Practice address fax:** (724) 452-6576
- **Mailing address:** PO BOX 70, ZELIENOPLE, PA 16063-0070
- **Mailing address phone:** (724) 452-4453
- **Mailing address fax:** (724) 452-6576

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 414650 | PA | Yes |

## Other

- **Enumeration date:** 12/22/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100754254-0019 | — | PA |