Organization
AVENUES
Active
Organization
AVENUES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER J KEITSOCK (EXECUTIVE DIRECTOR)
(570) 622-7920
Entity
Organization
Contact information
Practice address
2 PARK ST, POTTSVILLE, PA 17901-3827
(570) 622-7920
(570) 622-9271
Mailing address
2 PARK ST, POTTSVILLE, PA 17901-3827
(570) 622-7920
(570) 622-9271
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
Other
Enumeration date
12/21/2006
Last updated
01/23/2023
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