Little Creek Lodge

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

647020 Issued in PA

Legal business name

LITTLE CREEK LODGE

Practice address

359 Easton Tpke
Lake Ariel, PA 18436-4794

Phone

(570) 689-2644

Fax

(570) 689-2744

NPI assigned

Aug 26, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Barbara Warren-Pace

Title

Cfo

Phone

(570) 689-2644

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Practitioners 1

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

• Amanda Burnside, MA, ATR-BC, LPC

  • Professional Counselor
  • Lake Ariel, PA
  • NPI 1154889384
  NPD (past)

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

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377475200000",
    "number": "1508290636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 942",
            "city": "HAMLIN",
            "state": "PA",
            "postal_code": "184270942",
            "telephone_number": "570-689-2644",
            "fax_number": "570-689-2744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 EASTON TPKE",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184364794",
            "telephone_number": "570-689-2644",
            "fax_number": "570-689-2744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE CREEK LODGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-26",
        "last_updated": "2013-08-26",
        "status": "A",
        "authorized_official_last_name": "WARREN-PACE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-689-2644",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "PA",
            "license": "647020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dakota Kyzer
• Theresa A Lafranco, M.D.
• Jennifer Laity
• Lauren Lewis
• Lilybrook Wellness Center LLC
• Little Creek Outpatient Services LLC
• Lonewell Health LLC
• Myra Cummings Mabry, D.O.,
• Norina A Manassy, PAC
• Basya Marcus, MD

• Substance Abuse Rehabilitation Facility in Lake Ariel, PA
• Providers in Lake Ariel, PA by specialty
• Substance Abuse Rehabilitation Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; 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.