Provider Demographics
NPI:1861556839
Name:AVENUES
Entity type:Organization
Organization Name:AVENUES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEITSOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-7920
Mailing Address - Street 1:2 PARK ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3827
Mailing Address - Country:US
Mailing Address - Phone:570-622-7920
Mailing Address - Fax:570-622-9271
Practice Address - Street 1:2 PARK ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3827
Practice Address - Country:US
Practice Address - Phone:570-622-7920
Practice Address - Fax:570-622-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care