1336210699 NPI number — VIAQUEST BEHAVIAORL HEALTH OF PA, LLC

Table of content: (NPI 1336210699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336210699 NPI number — VIAQUEST BEHAVIAORL HEALTH OF PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIAQUEST BEHAVIAORL HEALTH OF PA, 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:
1336210699
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:
525 METRO PL N
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-5342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-645-3267
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 WOODS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-2082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
RICH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
800-645-3267

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  316910 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320800000X , with the licence number: 301480 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320800000X , with the licence number: 302410 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: 316970 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0019621050003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019621050001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019621050004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019621050002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0428 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5011962105 . This is a "CBHNP PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com