Organization
MARTHA LLOYD CRF 1ST STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MILLER (DIRECTOR)
(570) 297-2185
Entity
Organization
Contact information
Practice address
41 1ST ST, MANSFIELD, PA 16933-1211
(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
216180
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015544810044
—
PA
Enumeration date
06/17/2008
Last updated
06/17/2008
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