Basic Information
| Provider Information | |||||||||
| NPI: | 1902087869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKS COUNTY CHILDREN AND YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 COURT ST | ||||||||
| Address2: | 11TH FLOOR | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196014302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104786700 | ||||||||
| FaxNumber: | 6104784994 | ||||||||
| Practice Location | |||||||||
| Address1: | 633 COURT ST | ||||||||
| Address2: | 11TH FLOOR | ||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196014302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104786700 | ||||||||
| FaxNumber: | 6104784994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DELORES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | FISCAL OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6104786730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | PA | Y | Agencies | Nursing Care |
ID Information
| ID | Type | State | Issuer | Description | 1007581460011 | 05 | PA | MEDICAID |