Organization
NULTON DIAGNOSTIC AND TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY J NULTON PHD (CEO)
(814) 262-0025
Entity
Organization
Contact information
Practice address
608 EAST PITT STREET, BEDFORD, PA 15522
(814) 624-3121
Mailing address
608 EAST PITT STREET, BEDFORD, PA 16601
(814) 624-3121
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
312180, 312170
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007324900002
—
PA
05
—
1007324900016
—
PA
Enumeration date
05/24/2007
Last updated
12/13/2012
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