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Organization
LYCOMING-CLINTON JOINDER BOARD
Active
Organization
LYCOMING-CLINTON JOINDER BOARD
Active
Other names
Lycoming Clinton MHMR Program
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN DIDOMENICO (HUMAN SERVICES DIRECTOR)
(570) 323-6467
Entity
Organization
Contact information
Practice address
200 EAST ST, WILLIAMSPORT, PA 17701-6613
(570) 326-0924
(570) 326-1348
Mailing address
200 EAST ST, WILLIAMSPORT, PA 17701-6613
(570) 326-0924
(570) 326-1348
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007332180012
CAPITATION
PA
Enumeration date
06/21/2007
Last updated
08/22/2020
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