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Organization Active NPI

Wilkes Barre Behavioral Hospital Company LLC

Doing business as Community Residential Rehab #1

  • Mental Illness Community Based Residential Treatment Facility
  • Kingston, PA
National Provider Identifier
1093070583
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
221020 Issued in PA
Legal business name
WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC
Doing business as
Community Residential Rehab #1
Practice address
76 S Dawes Ave
Kingston, PA 18704-5710
Phone
(570) 718-0833
NPI assigned
Jul 10, 2012
Organization subpart
Yes
Parent organization
WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Paula Lalor
Title
Director/Delegated Official
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 221020 PA Primary

Addresses

Primary practice location

76 S Dawes Ave
Kingston, PA 18704-5710

Mailing address

562 Wyoming Ave
Kingston, PA 18704-3721
Phone (570) 552-3865

Other names 1

  • Community Residential Rehab #1 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wilkes-Barre Behav Hosp24 organizations share this tax ID, including this one
Part of
Wilkes-Barre Behav Hosp

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1093070583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043721",
            "telephone_number": "570-552-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 S DAWES AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045710",
            "telephone_number": "570-718-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILKES BARRE BEHAVIORAL HOSPITAL COMPANY LLC",
        "enumeration_date": "2012-07-10",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "PA",
            "license": "221020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Residential Rehab #1",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Residential Rehab #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingston, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.