Provider Demographics
NPI:1326117359
Name:BROOKVILLE BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:BROOKVILLE BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:PARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-371-1088
Mailing Address - Street 1:3 S BRADY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2159
Mailing Address - Country:US
Mailing Address - Phone:814-371-1088
Mailing Address - Fax:814-371-4966
Practice Address - Street 1:3 S BRADY ST STE 205
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2159
Practice Address - Country:US
Practice Address - Phone:814-371-1088
Practice Address - Fax:814-371-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA423220251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101087304Medicare ID - Type UnspecifiedMA PROVIDER NUMBER