Provider Demographics
NPI:1386892578
Name:NORTHEAST TREATMENT CENTER, INC.
Entity type:Organization
Organization Name:NORTHEAST TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
Mailing Address - Street 1:499 N 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4005
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-925-6897
Practice Address - Street 1:499 N 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4005
Practice Address - Country:US
Practice Address - Phone:215-451-7100
Practice Address - Fax:215-925-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807292251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE100022246Medicaid
DE1000022246OtherDIAMOND STATE PARTNERS
DE273261OtherMANAGED HEALTH NETWORK
PA296503000OtherMAGELLAN HEALTH CHOICES DELAWARE COUNTY
PA100773572Medicaid
DE217465OtherUNISON HEALTH PLAN
PA311749OtherMAGELLAN KEYSTONE HEALTH PLAN EAST
PA1000838OtherCOMMUNITY CARE BEHAVIORAL HEALTH
DE159997OtherBLUE CROSS OF DELAWARE
PA046410000OtherMAGELLAN - COMMERCIAL
PA462315000OtherMAGELLAN HEALTH CHOICES BUCKS/MONTGOMERY COUNTIES
PA0004972000OtherMAGELLAN - PERSONAL CHOICE