Provider Demographics
NPI:1104806793
Name:CRAWFORD COUNTY DRUG & ALCOHOL EXECUTIVE COMMISSION, INC.
Entity type:Organization
Organization Name:CRAWFORD COUNTY DRUG & ALCOHOL EXECUTIVE COMMISSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-724-4100
Mailing Address - Street 1:920 WATER ST
Mailing Address - Street 2:DOWNTOWN MALL
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3439
Mailing Address - Country:US
Mailing Address - Phone:814-724-4100
Mailing Address - Fax:814-333-2779
Practice Address - Street 1:920 WATER ST
Practice Address - Street 2:DOWNTOWN MALL
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3439
Practice Address - Country:US
Practice Address - Phone:814-724-4100
Practice Address - Fax:814-333-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA201084251B00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007582350006Medicaid
PA1007582350007Medicaid
PA1007582350005Medicaid