Organization
SECOND HAVEN SERVICES FOR YOUTH INC.
Active
Other names
Rose Resiliency Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM FREEMAN IV MBA (EXECUTIVE DIRECTOR)
(866) 343-5509
Entity
Organization
Contact information
Practice address
633 LAKESIDE DR, TOBYHANNA, PA 18466-9792
(866) 343-5509
(866) 343-5509
Mailing address
PO BOX 329, MOUNT POCONO, PA 18344-0329
(866) 343-5509
(866) 343-5509
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
MD037460L
PA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
223180
PA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
221370
PA
Other
Enumeration date
12/01/2009
Last updated
02/09/2015
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