Organization
TREHAB DRUG AND ALCOHOL OUTPATIENT PROGRAM
Active
Other names
Trehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS PHELPS (PROGRAM DIRECTOR)
(570) 278-5227
Entity
Organization
Contact information
Practice address
36 PUBLIC AVE, BOX 366, MONTROSE, PA 18801-1220
(570) 278-3338
Mailing address
36 PUBLIC AVE, 2ND FLOOR, MONTROSE, PA 18801-1220
(570) 278-3338
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
H6526601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100-730-1450005
MEDICAL ASSISTANCE
PA
01
—
100-730-1450006
MEDICAL ASSISTANCE
PA
01
—
100-730-1450007
MEDICAL ASSISTANCE
PA
Enumeration date
11/15/2007
Last updated
09/21/2015
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