Provider Demographics
NPI:1225215775
Name:FAYETTE CO. DRUG & ALCOHOL COMMISSION
Entity Type:Organization
Organization Name:FAYETTE CO. DRUG & ALCOHOL COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBONDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-438-3576
Mailing Address - Street 1:100 NEW SALEM RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8936
Mailing Address - Country:US
Mailing Address - Phone:724-438-3576
Mailing Address - Fax:724-438-3305
Practice Address - Street 1:100 NEW SALEM RD
Practice Address - Street 2:SUITE 106
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8936
Practice Address - Country:US
Practice Address - Phone:724-438-3576
Practice Address - Fax:724-438-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA53591OtherBLUE SHIELD PROVIDER #
PA1007582440009Medicaid
PA1517783OtherBLUE SHIELD PROVIDER #