1295721249 NPI number — MARY AND ALEXANDER LAUGHLIN CHILDREN'S CENTER

Table of content: (NPI 1295721249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295721249 NPI number — MARY AND ALEXANDER LAUGHLIN CHILDREN'S CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY AND ALEXANDER LAUGHLIN CHILDREN'S CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAUGHLIN CHILDREN'S CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295721249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 FREDERICK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-741-4087
Provider Business Mailing Address Fax Number:
412-741-6808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 FREDERICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWICKLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15143-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-741-4087
Provider Business Practice Location Address Fax Number:
412-741-6808
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FLOREY
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
412-741-4087

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 429437 . This is a "BCBS - PREMIERE NETWORK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015858230002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351738000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".




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