1407999766 NPI number — CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407999766 NPI number — CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

Employer Identification Number (EIN):

Provider Organization Name:

CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

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Provider Other Last Name Type Code:

NPI Number:

1407999766

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/26/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 219

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DANVILLE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17821-0219

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

570-275-5422

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

507 E MARKET ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DANVILLE

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17821

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-275-4962

Provider Business Practice Location Address Fax Number:

570-275-5754

Provider Enumeration Date:

02/15/2007

Authorized Official Last Name:

BEACH

Authorized Official First Name:

RICHARD

Authorized Official Middle Name:

D.

Authorized Official Title or Position:

ADMINISTRATOR

Authorized Official Telephone Number:

570-275-5422

• Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1000020900045 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900046 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900059 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900085 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900061 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900066 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900084 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900067 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900082 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900048 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900057 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000020900060 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".