Provider Demographics
NPI:1225772486
Name:BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS-PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-739-4265
Mailing Address - Street 1:1170 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2601
Mailing Address - Country:US
Mailing Address - Phone:178-598-8107
Mailing Address - Fax:800-915-6119
Practice Address - Street 1:333 S 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1464
Practice Address - Country:US
Practice Address - Phone:717-859-8810
Practice Address - Fax:800-915-6119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)