Provider Demographics
NPI:1316161706
Name:LUZERNE TREATMENT CENTER
Entity type:Organization
Organization Name:LUZERNE 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:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-744-9601
Mailing Address - Street 1:35 FAIRFIELD PL
Mailing Address - Street 2:COMMUNITY EDUCATION 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:215-634-8962
Practice Address - Street 1:600 E LUZERNE ST
Practice Address - Street 2:LUZERNE TREATMENT CENTERS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4228
Practice Address - Country:US
Practice Address - Phone:215-634-8960
Practice Address - Fax:215-634-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251S00000X
PA807372324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD0048OtherBHSI OF PHILADELPHIA
PA774372000OtherMAGELLAN BH OF PA
PA88868OtherCBH
PA01824913Medicaid