Provider Demographics
NPI:1730335522
Name:TWILIGHT BEGINNINGS OF MT. CARMEL
Entity type:Organization
Organization Name:TWILIGHT BEGINNINGS OF MT. CARMEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CICCHIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:570-875-8058
Mailing Address - Street 1:601 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1803
Mailing Address - Country:US
Mailing Address - Phone:570-875-8058
Mailing Address - Fax:570-554-4357
Practice Address - Street 1:35 WEST AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1303
Practice Address - Country:US
Practice Address - Phone:570-875-9434
Practice Address - Fax:570-554-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 363L00000X
PA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)