1659133668 NPI number — SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT

Table of content: (NPI 1659133668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659133668 NPI number — SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
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:
1659133668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 W 26TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16508-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-451-2232
Provider Business Mailing Address Fax Number:
814-454-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2556 W 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16505-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-835-2960
Provider Business Practice Location Address Fax Number:
814-833-0879
Provider Enumeration Date:
01/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
FAUBLE
Authorized Official First Name:
MANDY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR CLINICAL CARE SERVICES
Authorized Official Telephone Number:
814-451-2225

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 455580 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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