1376654053 NPI number — JAMES & CHAROLETTE ENTERPRISES INC.

Table of content: (NPI 1376654053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376654053 NPI number — JAMES & CHAROLETTE ENTERPRISES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES & CHAROLETTE ENTERPRISES INC.
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:
MT. WASHINGTON PSYCHIATRIC SERVICES
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:
1376654053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 SOUTHERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15211-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-431-0711
Provider Business Mailing Address Fax Number:
412-431-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 SOUTHERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15211-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-431-0711
Provider Business Practice Location Address Fax Number:
412-431-0732
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHESLEIGH
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SUPERVISOR
Authorized Official Telephone Number:
412-431-0711

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 669514 . This is a "KEYSTONE HEALTH PLAN WEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7771371 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528183 . This is a "CBHNP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100751029-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A895014 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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