NPIMap

Organization Active NPI

Second Haven Services for Youth Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Tobyhanna, PA
National Provider Identifier
1053649178
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
221370 Issued in PA
Legal business name
SECOND HAVEN SERVICES FOR YOUTH INC.
Practice address
633 Lakeside Dr
Tobyhanna, PA 18466-9792
Phone
(866) 343-5509
Fax
(866) 343-5509
NPI assigned
Dec 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Freeman IV, MBA
Title
Executive Director
Phone
(866) 343-5509

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TP0016X MD037460L PA
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 223180 PA
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 221370 PA Primary

Addresses

Primary practice location

633 Lakeside Dr
Tobyhanna, PA 18466-9792

Mailing address

PO Box 329
Mount Pocono, PA 18344-0329
Phone (866) 343-5509

Other names 1

  • Rose Resiliency Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Second Haven Services for Youth Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1053649178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 329",
            "city": "MOUNT POCONO",
            "state": "PA",
            "postal_code": "183440329",
            "telephone_number": "866-343-5509",
            "fax_number": "866-343-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 LAKESIDE DR",
            "city": "TOBYHANNA",
            "state": "PA",
            "postal_code": "184669792",
            "telephone_number": "866-343-5509",
            "fax_number": "866-343-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND HAVEN SERVICES FOR YOUTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-01",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "866-343-5509",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "PA",
            "license": "MD037460L",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "PA",
            "license": "223180",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "PA",
            "license": "221370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rose Resiliency Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tobyhanna, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.