Organization Name: | LYCOMING-CLINTON MHMR PROGRAM |
NPI Number: | 1770636573 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DOBORAH M DUFFY (ADMINISTRATOR) |
Mailing Address: | 200 East Street The Sharwell Building Williamsport |
State: | PA US |
Postal Code: | 17701 |
Phone Number: | 5703260924 |
Fax Number: | 5703261348 |
NPI Enumeration Date: | 01/18/2007 |
NPI Last Update Date: | 12/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |