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National Provider Identifiers Registry

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1700996790 ADVANCED TREATMENT SYSTEMS DBA LEBANON

TREATMENT CENTER

NPI

1700996790 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.

Entity Type

Organization Code describing the type of health care provider that is being assigned an NPI. Codes are:

<ul>

<li>1 = (Person): individual human being who furnishes health care;</li>

<li>2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).</li>

</ul>

Provider Organization

Name (Legal Business

Name)

ADVANCED TREATMENT SYSTEMS DBA LEBANON TREATMENT CENTER

Provide organization name (legal business name used to file tax returns with the IRS). The

Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right

parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.

Provider First Line

Business Mailing

Address

3030 CHESTNUT ST The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.

Provider Business

Mailing Address City

Name

LEBANON The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.

Provider Business

Mailing Address State

Name

PA The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.

Provider Business

Mailing Address

Postal Code

17042-2518 The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.

Provider Business

Mailing Address

Country Code

US The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.

Provider Business

Mailing Address

Telephone Number

717-273-8000 The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.

Provider First Line

Business Practice

Location Address

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Provider Business

Practice Location

Address City Name

LEBANON The city name in the location address of the provider being identified.

Provider Business

Practice Location

Address State Name

PA The State or Province name in the location address of the provider being identified.

Provider Business

Practice Location

Address Postal Code

17042-2518 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

Provider Business

Practice Location

Address Country Code

US The country code in the location address of the provider being identified.

Provider Business

Practice Location

Address Telephone

Number

717-273-8000 The telephone number associated with the location address of the provider being identified.

Provider Enumeration

Date

08/30/2006 The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date

07/08/2007 The date that a record was last updated or changed.

Authorized Official

Last Name

HERSCHMAN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.

Authorized Official

First Name

PHIL The first name of the authorized official

Authorized Official

Title or Position

OTP DIVISION PRESIDENT

The title or position of the authorized official

Authorized Official

Telephone Number

760-918-8700 The 10-position telephone number of the authorized official.

Healthcare Provider

Taxonomy Code #1

261QM2800X The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

Healthcare Provider

Taxonomy 1

Methadone Healthcare Provider Taxonomy #1

Healthcare Provider

Primary Taxonomy

Switch 1

Y Primary Taxonomy: <ul>

<li>X - The primary taxonomy switch is Not Answered;</li>

<li>Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);</li> <li>N - The taxonomy is not the primary taxonomy.</li>

</ul>

Other Provider

Identifier 1

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Other Provider

Identifier Type 1

MEDICAID Other Provider Identifier Type #1

Other Provider

Identifier State 1

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