NPIMap

Organization Active NPI

Crawford County Drug & Alcohol Executive Commission, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Meadville, PA
National Provider Identifier
1104806793
Registry record updated Aug 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
201084 Issued in PA
Legal business name
CRAWFORD COUNTY DRUG & ALCOHOL EXECUTIVE COMMISSION, INC.
Practice address
920 Water St
Downtown Mall
Meadville, PA 16335-3439
Phone
(814) 724-4100
Fax
(814) 333-2779
NPI assigned
Jan 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2007

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

Authorized official

Name
Deborah J. Duffy
Title
Executive Director
Phone
(814) 724-4100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 201084 PA
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 201084 PA Primary

Addresses

Primary practice location

920 Water St
Downtown Mall
Meadville, PA 16335-3439

Mailing address

920 Water St
Downtown Mall
Meadville, PA 16335-3439
Phone (814) 724-4100

Other identifiers 3

IdentifierTypeStateIssuer
1007582350006MedicaidPA
1007582350007MedicaidPA
1007582350005MedicaidPA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2134664Crawford County Drug & Alcohol Executive Commissio920 Water St Downtown Mall, Meadville, PA 16335Certificate of waiverAug 7, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186099200000",
    "number": "1104806793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 WATER ST",
            "address_2": "DOWNTOWN MALL",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353439",
            "telephone_number": "814-724-4100",
            "fax_number": "814-333-2779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 WATER ST",
            "address_2": "DOWNTOWN MALL",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353439",
            "telephone_number": "814-724-4100",
            "fax_number": "814-333-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAWFORD COUNTY DRUG & ALCOHOL EXECUTIVE COMMISSION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2007-08-03",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "814-724-4100"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "PA",
            "license": "201084",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "201084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007582350006",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007582350007",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007582350005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meadville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.