Provider Demographics
NPI:1275526642
Name:CHARTIERS COMMUNITY MENTAL HEALTH AND RETARDATION CENTER, INC
Entity Type:Organization
Organization Name:CHARTIERS COMMUNITY MENTAL HEALTH AND RETARDATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-221-3302
Mailing Address - Street 1:437 RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017
Mailing Address - Country:US
Mailing Address - Phone:412-221-3302
Mailing Address - Fax:412-221-4902
Practice Address - Street 1:437 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017
Practice Address - Country:US
Practice Address - Phone:412-221-3302
Practice Address - Fax:412-221-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
PA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100002895Medicaid
PA100002895Medicaid