Basic Information
| Provider Information | |||||||||
| NPI: | 1841289733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEN CLEAR CHILD SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 319 | ||||||||
| Address2: | 50 BIGLER ROAD | ||||||||
| 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: | 8143425678 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 406200 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103TC2200X | 406200 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 106H00000X | 406200 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 163W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 164W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 251B00000X | 406200 | PA | N | Agencies | Case Management | 251S00000X | N | Agencies | Community/Behavioral Health | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 101YM0800X | 406200 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1000053220042 | 05 | PA | MEDICAID | 100005322 | 05 | PA | MEDICAID | 1000053220037 | 05 | PA | MEDICAID | 1000053220039 | 05 | PA | MEDICAID | 1000053220041 | 05 | PA | MEDICAID | 1000053220001 | 05 | PA | MEDICAID | 1000053220044 | 05 | PA | MEDICAID | 1000053220024 | 05 | PA | MEDICAID | 1000053220040 | 05 | PA | MEDICAID |