| Organization Name: | LUZERNE WYOMING COUNTY MH CENTER #1 |
| NPI Number: | 1568583474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH H KNECHT (CEO) |
| Mailing Address: | R 307 Laird Street Wilkes-barre |
| State: | PA US |
| Postal Code: | 18702 |
| Phone Number: | 5704089320 |
| Fax Number: | 5704089324 |
| NPI Enumeration Date: | 04/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |