Basic Information
| Provider Information | |||||||||
| NPI: | 1083744338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY COUNTY EMERGENCY SERVICE CRISIS RESIDENTIAL PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BEECH DRIVE | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | 6102790978 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 EAGLEVILLE ROAD | ||||||||
| Address2: | ACADIA HOUSE | ||||||||
| City: | EAGLESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194031829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106312480 | ||||||||
| FaxNumber: | 6106312485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6102796100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 103720 | PA | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 1007568020016 | 05 | PA | MEDICAID |