Provider Demographics
NPI:1548512452
Name:POCONO MOUNTAIN RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:POCONO MOUNTAIN RECOVERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:3437 ROUTE 715
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-7785
Mailing Address - Country:US
Mailing Address - Phone:570-629-3270
Mailing Address - Fax:570-620-9025
Practice Address - Street 1:3437 ROUTE 715
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18332-7785
Practice Address - Country:US
Practice Address - Phone:561-921-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center