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Children'S Center for Treatment and Education

Organization Active NPI Psychiatric Residential Treatment Facility · Ulster, PA

NPI 1083736722 · NPPES record last updated Nov 4, 2020

Key facts

NPI
1083736722
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatric Residential Treatment Facility 323P00000X
License
227240 (PA)
Legal business name
CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
Practice address
100 Robert Gabriel Drive
Suite B
Ulster, PA 18850-0000
Phone
(814) 817-1400
Fax
(814) 817-1447
NPI assigned
Apr 4, 2007
Organization subpart
No

Authorized official

Name
Mrs. Bridget V Mangold
Title
Controller
Phone
(814) 817-1400

Corporate family (same tax ID) 13

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

National Provider Directory

Tax ID family
Beacon Light Behavioral Health System (14 organizations share this tax ID)

Locations

100 Robert Gabriel Dr
Ste A
Ulster, PA 18850

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 227240 PA Yes

Addresses

Primary practice location

100 Robert Gabriel Drive
Suite B
Ulster, PA 18850-0000

Mailing address

800 East Main Street
Bradford, PA 16701-3278
Phone (814) 817-1400

Other practice location 1

100 Robert Gabriel Dr
Suite A
Ulster, PA 18850-0000
Phone (814) 817-1400

Other identifiers

IdentifierTypeStateIssuer
1007710210094MedicaidPA

Other names

  • Beacon Light Behavioral Health System Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2020.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1083736722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 EAST MAIN STREET",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "167013278",
            "telephone_number": "814-817-1400",
            "fax_number": "814-817-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ROBERT GABRIEL DRIVE",
            "address_2": "SUITE B",
            "city": "ULSTER",
            "state": "PA",
            "postal_code": "188500000",
            "telephone_number": "814-817-1400",
            "fax_number": "814-817-1447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Robert Gabriel Dr",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Ulster",
            "state": "PA",
            "postal_code": "188500000",
            "country_code": "US",
            "telephone_number": "814-817-1400",
            "fax_number": "814-817-1447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDREN'S CENTER FOR TREATMENT AND EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "MANGOLD",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "814-817-1400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "PA",
            "license": "227240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007710210094",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Light Behavioral Health System",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beacon Light Behavioral Health System",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ulster, PA

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Sources for this page

Verify at the official NPI Registry.