1013019405 NPI number — HEALTHQUEST BEHAVIORAL SERVICES, LLC

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 1013019405 NPI number — HEALTHQUEST BEHAVIORAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHQUEST BEHAVIORAL SERVICES, LLC
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:
1013019405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 BRAUNLICH DR
Provider Second Line Business Mailing Address:
SUITE 480 - MCKNIGHT PLAZA
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-358-8666
Provider Business Mailing Address Fax Number:
412-358-8684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 BRAUNLICH DR
Provider Second Line Business Practice Location Address:
SUITE 480 - MCKNIGHT PLAZA
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-358-8666
Provider Business Practice Location Address Fax Number:
412-358-8684
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROEMER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
412-358-8666

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1709706 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 062810 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 387693 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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