1396994885 NPI number — CONNEAUT VALLEY HEALTH CENTER INC.

Table of content: (NPI 1396994885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396994885 NPI number — CONNEAUT VALLEY HEALTH CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNEAUT VALLEY HEALTH CENTER 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:
CONNEAUT VALLEY MENTAL HEALTH
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:
1396994885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 WASHINGTON ST
Provider Second Line Business Mailing Address:
PO BOX E
Provider Business Mailing Address City Name:
CONNEAUTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16406-7138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-373-2276
Provider Business Mailing Address Fax Number:
814-587-2918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 TERRACE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16335-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-373-2976
Provider Business Practice Location Address Fax Number:
814-333-7071
Provider Enumeration Date:
09/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DOWNING
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
814-373-2449

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW015852 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007230030015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE7746 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 191386 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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