Provider Demographics
NPI:1316086655
Name:MINSEC TREATMENT CENTER
Entity type:Organization
Organization Name:MINSEC TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RE-ENTRY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BERTEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-744-9601
Mailing Address - Street 1:35 FAIRFIELD PL
Mailing Address - Street 2:COMMUNITY EDUCATIONS CENTERS
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6206
Mailing Address - Country:US
Mailing Address - Phone:973-226-2900
Mailing Address - Fax:
Practice Address - Street 1:3768 L ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5530
Practice Address - Country:US
Practice Address - Phone:215-744-9601
Practice Address - Fax:215-743-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807220261QR0405X
PA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008795900000Medicare ID - Type UnspecifiedDRUG AND ALCOHOL CLINIC