Organization
OFFICE OF LABOR & INDUSTRY
Active
Other names
Comw of PA Dept of Labor&Industry Hiram G Andrews Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER R ZAKRAYSEK MS (DIRECTOR OF INSTITUTIONAL MANAGEMEN)
(814) 254-0442
Entity
Organization
Contact information
Practice address
727 GOUCHER ST, JOHNSTOWN, PA 15905-3025
(814) 254-0442
(814) 254-0466
Mailing address
1407 EISENHOWER BLVD, SUITE 104, JOHNSTOWN, PA 15904-3262
(814) 269-1494
(814) 266-8572
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
5343
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLICATION ON FILE
—
PA
Enumeration date
11/25/2013
Last updated
10/10/2014
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