Provider Demographics
NPI:1154172658
Name:COLD BORE COUNSELING
Entity type:Organization
Organization Name:COLD BORE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GILGALLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-880-7614
Mailing Address - Street 1:1822 SANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1867
Mailing Address - Country:US
Mailing Address - Phone:570-591-3288
Mailing Address - Fax:570-209-7465
Practice Address - Street 1:1822 SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1867
Practice Address - Country:US
Practice Address - Phone:570-291-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility