Organization
MARTHA LLOYD CRF BROOKSIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MILLER (DIRECTOR)
(570) 297-2185
Entity
Organization
Contact information
Practice address
70 BALLARD ST, TROY, PA 16947
(570) 297-2185
(570) 297-1019
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
05
—
1015544810012
—
PA
Enumeration date
07/15/2008
Last updated
07/15/2008
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