Organization
MARTHA LLOYD CRF DAY PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MILLER (CRF DIRECTOR)
(570) 297-2185
Entity
Organization
Contact information
Practice address
190 W MAIN ST, TROY, PA 16947-1131
(570) 297-2185
Mailing address
190 W MAIN ST, TROY, PA 16947-1131
(570) 297-2185
(570) 297-1019
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000699330
HIGHMARK BLUE SHIELD
PA
05
—
1015544810013
—
PA
01
—
1093843906
KARI WOOD
PA
01
—
1316910318
MS. LORI LEE PERRY CRNP
PA
01
—
1710946686
DR VANCE GOOD, MD
PA
01
—
1750361945
PHYSICIANCARE PC
PA
Enumeration date
08/17/2006
Last updated
03/09/2009
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