Provider Demographics
NPI:1427865104
Name:CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Entity type:Organization
Organization Name:CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-578-9600
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:484-240-9272
Mailing Address - Fax:570-300-2326
Practice Address - Street 1:101 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1343
Practice Address - Country:US
Practice Address - Phone:570-340-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100006375Medicaid