Provider Demographics
NPI:1720742208
Name:WILKES BARRE TREATMENT LLC
Entity type:Organization
Organization Name:WILKES BARRE TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-7707
Mailing Address - Street 1:950 N FEDERAL HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4314
Mailing Address - Country:US
Mailing Address - Phone:954-533-7707
Mailing Address - Fax:
Practice Address - Street 1:1106 E. NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:LAUREL RUN
Practice Address - State:PA
Practice Address - Zip Code:18706
Practice Address - Country:US
Practice Address - Phone:954-533-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILKES BARRE TREATMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder