1861422834 NPI number — CLARION CO MH MR DRUG & ALCOHOL

Table of content: (NPI 1861422834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861422834 NPI number — CLARION CO MH MR DRUG & ALCOHOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARION CO MH MR DRUG & ALCOHOL
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:
1861422834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 S 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16214-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-226-6252
Provider Business Mailing Address Fax Number:
814-226-8564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 S 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16214-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-226-6252
Provider Business Practice Location Address Fax Number:
814-226-8564
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DITTMAN
Authorized Official First Name:
EVAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MH MR DRUG & ALCOHOL ADMINISTRATOR
Authorized Official Telephone Number:
814-226-6252

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1000073900014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 660501 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4634563 . This is a "AETNA INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000073900008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007390025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000073900006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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