Organization
JUVENILE UPLIFTING MENTORING PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INTISAR MARTIN CRS, MS (EXECUTIVE DIRECTOR)
(267) 326-7959
Entity
Organization
Contact information
Practice address
734 W 4TH ST, WILLIAMSPORT, PA 17701-5904
(267) 326-7959
Mailing address
293 MAIN ST, WILLIAMSPORT, PA 17702-7312
(267) 326-7959
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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