Provider Demographics
NPI:1306962808
Name:CHILDREN'S ADVOCACY CENTER OF LAWRENCE COUNTY, INC.
Entity type:Organization
Organization Name:CHILDREN'S ADVOCACY CENTER OF LAWRENCE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-658-4688
Mailing Address - Street 1:1000 S MERCER ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4672
Mailing Address - Country:US
Mailing Address - Phone:724-658-4688
Mailing Address - Fax:724-658-8810
Practice Address - Street 1:1000 S MERCER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4672
Practice Address - Country:US
Practice Address - Phone:724-658-4688
Practice Address - Fax:724-658-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016550810001Medicaid