Provider Demographics
NPI:1962680751
Name:NORTHEAST TREATMENT CENTERS. INC.
Entity type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
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 D-E
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:2008-02-05
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA910194251S00000X, 261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119254OtherCOMMUNITY BEHAVIORAL HEAL
DE159997OtherBLUE CROSS DELAWARE
PA296503000OtherMAGELLAN HEALTH CHOICES
PA311749OtherMAGELLAN - KEYSTONE HPE
DE1000022246OtherDIAMOND STATE PARTNERS
DE273261OtherMANAGED HEALTH NETWORK
PA273261OtherMANAGED HEALTH NETWORK
PA0004972000OtherMAGELLAN PERSONAL CHOICE
PA100773886Medicaid
PA462315000OtherMAGELLAN HEALTH CHOICES
119272OtherCOMMUNTIY BEHAVIORAL HEAL
DE046410000OtherMAGELLAN COMMERCIAL
PA046410000OtherMAGELLAN COMMERCIAL
DE100022246Medicaid
DE217465OtherUNISON HEALTH PLAN