1871891168 NPI number — AXIOM FAMILY COUNSELING SERVICES, 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 1871891168 NPI number — AXIOM FAMILY COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AXIOM FAMILY COUNSELING SERVICES, 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:
1871891168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 W PITTSBURGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELMONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15626-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-472-9466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 CHERRY TREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-439-0308
Provider Business Practice Location Address Fax Number:
724-439-0378
Provider Enumeration Date:
03/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VISNICK
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROJECT DIRECTOR
Authorized Official Telephone Number:
866-472-9466

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  433860 , 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: 433860 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 267015 . This is a "PA DEPT OF HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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