Organization
NORTHEAST TREATMENT CENTERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNEMARIE STINSON (BILLING MANAGER)
(215) 451-7015
Entity
Organization
Contact information
Practice address
1709 WASHINGTON AVE, PHILADELPHIA, PA 19146-1913
(215) 546-8060
(215) 925-6897
Mailing address
499 N 5TH ST, SUITE A, PHILADELPHIA, PA 19123-4005
(215) 451-7000
(215) 925-6897
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
140040
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004972000
INDEPENDENCE BLUE CROSS
PA
05
—
100773572
—
PA
01
—
311749
KEYSTONE HEALTH PLAN EAST
PA
Enumeration date
07/30/2013
Last updated
07/30/2013
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