Provider Demographics
NPI:1306184775
Name:CPP BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:CPP BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PONKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-550-4343
Mailing Address - Street 1:180 N GALLATIN AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2969
Mailing Address - Country:US
Mailing Address - Phone:724-550-4343
Mailing Address - Fax:
Practice Address - Street 1:180 N GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2969
Practice Address - Country:US
Practice Address - Phone:724-550-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-19
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA444760251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA444760Medicaid
PA267020OtherPA DEPT OF HEALTH
PA10280554000001Medicaid