Provider Demographics
NPI:1902087869
Name:BERKS COUNTY CHILDREN AND YOUTH SERVICES
Entity Type:Organization
Organization Name:BERKS COUNTY CHILDREN AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-478-6730
Mailing Address - Street 1:633 COURT ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-4302
Mailing Address - Country:US
Mailing Address - Phone:610-478-6700
Mailing Address - Fax:610-478-4994
Practice Address - Street 1:633 COURT ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-4302
Practice Address - Country:US
Practice Address - Phone:610-478-6700
Practice Address - Fax:610-478-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007581460011Medicaid