Active NPI
Children'S Center for Treatment and Education
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Warren, PA
National Provider Identifier
1366609646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- CHILDREN'S CENTER FOR TREATMENT AND EDUCATION
- Practice address
- 1885 Market St
Warren, PA 16365-1227 - Phone
- (814) 817-1400
- Fax
- (814) 817-1447
- NPI assigned
- May 22, 2008
- Organization subpart
- Yes
- Parent organization
- CHILDREN'S HOME OF BRADFORD
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Susan R Teconchuk
- Title
- Contract Manager
- Phone
- (814) 817-1400
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Public Health or Welfare Agency | 251K00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Clinic/Center | 261Q00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary | ||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
1885 Market St
Warren, PA 16365-1227
Mailing address
800 E Main St
Bradford, PA 16701-3278
Phone (814) 817-1400
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007710210084 | Medicaid | PA | |
| 1007710210088 | Medicaid | PA | |
| 1007710210114 | Medicaid | PA | |
| 1007710210057 | Medicaid | PA | |
| 1007710210071 | Medicaid | PA | |
| 1007710210079 | Medicaid | PA | |
| 1007710210081 | Medicaid | PA | |
| 1007710210083 | Medicaid | PA | |
| 1007710210087 | Medicaid | PA | |
| 1007710210075 | Medicaid | PA | |
| 1007710210092 | Medicaid | PA | |
| 1007710210108 | Medicaid | PA | |
| 1007710210076 | Medicaid | PA |
Other names 2
- Beacon Light Behavioral Health System
- Beacon Light Behavioral Health Systems
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090312000564 | PA | Part B Supplier - Clinic/Group Practice | 4880750017 |
Receives reassigned benefits from 21 practitioners 1 other NPI on this enrollment Practice locations: Bradford, PA; Tionesta, PA; Warren, PA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Clinical Psychologist
- Bradford, PA
- NPI 1477626992
O20090312000564
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 21
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": "1211414400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607040000000",
"number": "1366609646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 E MAIN ST",
"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": "1885 MARKET ST",
"city": "WARREN",
"state": "PA",
"postal_code": "163651227",
"telephone_number": "814-817-1400",
"fax_number": "814-817-1447"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHILDREN'S CENTER FOR TREATMENT AND EDUCATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CHILDREN'S HOME OF BRADFORD",
"enumeration_date": "2008-05-22",
"last_updated": "2020-12-04",
"certification_date": "2020-12-04",
"status": "A",
"authorized_official_last_name": "TECONCHUK",
"authorized_official_first_name": "SUSAN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "CONTRACT MANAGER",
"authorized_official_telephone_number": "814-817-1400",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": null,
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210084",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210088",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210114",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210057",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210071",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210079",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210081",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210083",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210087",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210075",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210092",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210108",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007710210076",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Beacon Light Behavioral Health System",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Beacon Light Behavioral Health Systems",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Beacon Light Behavioral Health Systems",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Warren, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.