NPIMap

Organization Active NPI

Clem-Mar House, Inc.

  • Substance Abuse Rehabilitation Facility
  • Edwardsville, PA
National Provider Identifier
1790908812
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
407043 Issued in PA
Legal business name
CLEM-MAR HOUSE, INC.
Practice address
540 Main St
Edwardsville, PA 18704-2504
Phone
(570) 288-0403
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sonya Mowry, BS, MS, CCMS, CCDP
Title
Assistant Project Director
Phone
(570) 288-0403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 407043 PA Primary

Addresses

Primary practice location

540 Main St
Edwardsville, PA 18704-2504

Mailing address

PO Box 2028
Kingston, PA 18704-7038
Phone (570) 288-0403

Other identifiers 1

IdentifierTypeStateIssuer
0016199680001MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Clem-Mar House Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790908812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2028",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187047038",
            "telephone_number": "570-288-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MAIN ST",
            "city": "EDWARDSVILLE",
            "state": "PA",
            "postal_code": "187042504",
            "telephone_number": "570-288-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEM-MAR HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOWRY",
        "authorized_official_first_name": "SONYA",
        "authorized_official_title_or_position": "ASSISTANT PROJECT DIRECTOR",
        "authorized_official_telephone_number": "570-288-0403",
        "authorized_official_credential": "BS, MS, CCMS, CCDP"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "PA",
            "license": "407043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016199680001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwardsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.