Basic Information
| Provider Information | |||||||||
| NPI: | 1164952677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEN CLEAR CHILD SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BIGLER ROAD, PO BOX 319 | ||||||||
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| City: | BIGLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168250319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1633 PHILIPSBURG BIGLER HWY | ||||||||
| Address2: | |||||||||
| City: | PHILIPSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168668112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425845 | ||||||||
| FaxNumber: | 8143420532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAAB | ||||||||
| AuthorizedOfficialFirstName: | PAULINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8143425678 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 100005322 | 05 | PA | MEDICAID |