1538215926 NPI number — FAYETTE CO. DRUG & ALCOHOL COMMISSION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538215926 NPI number — FAYETTE CO. DRUG & ALCOHOL COMMISSION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYETTE CO. DRUG & ALCOHOL COMMISSION, 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:
Provider Other Organization Name Type Code:
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:
1538215926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 NEW SALEM RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-8936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-438-3576
Provider Business Mailing Address Fax Number:
724-438-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 NEW SALEM RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-3576
Provider Business Practice Location Address Fax Number:
724-438-3305
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHERBONDY
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
724-438-3576

Provider Taxonomy Codes

  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1517783 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 328848A336407 . This is a "VALUE BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1851372403 . This is a "NPI COUNSELOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007582440007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 588527000 . This is a "MAGELLAN AND AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 53591 . This is a "PREMIER BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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