WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC (NPI# 1073842936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073842936 |
| Entity Type | Organization |
| Organization Name | WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC |
| Practice Address |
562 Wyoming Ave Kingston PA 18704-3721 |
| Practice Telephone | 5705523700 |
| Practice Fax Number | 5705523733 |
| Mailing Telephone | 5705523700 |
| Mailing Fax Number | 5705523733 |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |
| Authorized Official Name | LAURIE HOLTSFORD (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 6154657466 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | Nursing Service Providers | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093070583 | Wilkes Barre Behavioral Hospital Company LLC | Community Based Residential Treatment Facility, Mental Illness | 76 S Dawes Ave, Kingston, PA 18704-5710 | 2012-07-10 |
| 1649535139 | Wilkes Barre Behavioral Hospital Company LLC | Community Based Residential Treatment Facility, Mental Illness | 3504 Bear Creek Blvd, Bear Creek Township, PA 18702-9760 | 2012-07-10 |
| 1982835484 | Wilkes Barre Behavioral Hospital Company LLC | Case Management | 110 S Pennsylvania Ave, Wilkes Barre, PA 18701-3301 | 2009-07-31 |
| 1669608477 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 99 Bridge St, Tunkhannock, PA 18657-1303 | 2009-06-08 |
| 1114153921 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-08 |
| 1477789287 | Wilkes Barre Behavioral Hospital Company LLC | Case Management | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-08 |
| 1386870194 | Wilkes Barre Behavioral Hospital Company LLC | Case Management | 110 S Pennsylvania Ave, Wilkes Barre, PA 18701-3301 | 2009-06-08 |
| 1376779181 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 110 S Pennsylvania Ave, Wilkes Barre, PA 18701-3301 | 2009-06-08 |
| 1568698371 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 110 S Pennsylvania Ave, Wilkes Barre, PA 18701-3301 | 2009-06-08 |
| 1992931893 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-05 |
| Street Address |
562 WYOMING AVE |
| City | KINGSTON |
| State | PA |
| Zip Code | 18704-3721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780683417 | David Liskov | Psychiatry & Neurology | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2005-07-15 |
| 1376186064 | Brent Smith | Registered Nurse | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2019-10-24 |
| 1275812661 | Roseanne P Pace | Counselor | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2011-08-16 |
| 1609172170 | Brittany Bahner | Counselor | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2011-02-01 |
| 1528368826 | Mary Repasky | Counselor | 562 Wyoming Ave, Choices Program of Wyoming Valley, Kingston, PA 18704 | 2010-11-02 |
| 1285862409 | David Liskov, Md | Psychiatry & Neurology | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-25 |
| 1013144211 | Md.mushfiqur Rahman | Psychiatry & Neurology | 562 Wyoming Ave, First Hospital, Kingston, PA 18704-3721 | 2009-06-15 |
| 1114153921 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-08 |
| 1477789287 | Wilkes Barre Behavioral Hospital Company LLC | Case Management | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-08 |
| 1992931893 | Wilkes Barre Behavioral Hospital Company LLC | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2009-06-05 |
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|---|---|---|---|---|
| 1013557552 | Millmark Health Inc. | Psychiatry & Neurology | 511 Pierce Street, Kingston, PA 18704 | 2020-01-13 |
| 1427550334 | Michael Anthony Waltich | Military Health Care Provider | 82 Cooper Street, Pringle, PA 18704 | 2018-03-06 |
| 1376088435 | Jae LLC | Massage Therapist | 512 Northhampton Street, Edwardsville, PA 18704 | 2016-12-28 |
| 1306278288 | Mohammad Khaled Tashkandi | Internal Medicine | 490 Northampton St Ste 1, Edwardsville, PA 18704 | 2013-08-02 |
| 1396180014 | Sammie Craven IIi | Pharmacist | 96 1st Avenue, Kingston, PA 18704 | 2013-05-08 |
| 1447693114 | Catherine Mary Harding | Nurse Practitioner | 141 South Maple Ave, Kingston, PA 18704 | 2013-04-12 |
| 1861781403 | Jennifer Ann Richards | Pharmacist | 22 West Side Mall, Edwardsville, PA 18704 | 2011-04-05 |
| 1558512772 | Jolon Theresa Sherin | Speech-Language Pathologist | 1825 Sans Souci Highway, Hanover, PA 18704 | 2008-10-07 |
| 1932361102 | Kari Ann Pietralczyk | Audiologist | 190 Welles Street, Forty-fort, PA 18704 | 2008-06-30 |
| 1467584151 | John Christopher Storti | Chiropractor | 180 United Penn Plaza, Kingston, PA 18704 | 2007-03-09 |
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| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
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| 1952422354 | Luzerne Wyoming County Mh Center #1 | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2007-04-03 |
| 1760428650 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2006-06-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.