Organization
CMSU MH/MR AND D&A PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP T KEATING (ADMINISTRATOR)
(570) 275-5422
Entity
Organization
Contact information
Practice address
460 W MAIN ST, BLOOMSBURG, PA 17815-1592
(570) 387-1132
Mailing address
PO BOX 219, DANVILLE, PA 17821-0219
(570) 275-5422
(570) 275-6610
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
326360
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191259
COUNTY FUNDED
PA
Enumeration date
06/13/2013
Last updated
06/13/2013
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