Provider Demographics
NPI:1053436212
Name:NORTHEAST TREATMENT CENTERS
Entity type:Organization
Organization Name:NORTHEAST TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-451-7000
Mailing Address - Street 1:7520 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3411
Mailing Address - Country:US
Mailing Address - Phone:215-451-7000
Mailing Address - Fax:215-451-7110
Practice Address - Street 1:2205 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1313
Practice Address - Country:US
Practice Address - Phone:215-451-7000
Practice Address - Fax:215-451-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA910194324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159997OtherBLUE CROSS DELAWARE
PA273261OtherMANAGED HLTH NETWORK
PA046410000OtherMAGELLAN-COMMERCIAL
PA0004972000OtherMAGELLAN-PERSONAL CHOICE
PA1007738860035Medicaid
PA311749OtherMAGELLAN-KEYSTONE HPE