Provider Demographics
NPI:1871943241
Name:RCAA HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:RCAA HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-415-8016
Mailing Address - Street 1:415 E SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-4964
Mailing Address - Country:US
Mailing Address - Phone:570-415-8016
Mailing Address - Fax:888-876-4781
Practice Address - Street 1:11603 STATE ROUTE 61
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2583
Practice Address - Country:US
Practice Address - Phone:570-416-8016
Practice Address - Fax:888-876-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PA497026261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA497026OtherDEPARTMENT OF DRUG AND ALCOHOL PROGRAMS