Organization
WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE HOLTSFORD (AUTHORIZED OFFICIAL)
(615) 465-7466
Entity
Organization
Contact information
Practice address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3700
(570) 552-3733
Mailing address
562 WYOMING AVE, KINGSTON, PA 18704-3721
(570) 552-3700
(570) 552-3733
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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