Provider Demographics
NPI:1467501312
Name:MERCY LIFE CENTER CORPORATION
Entity Type:Organization
Organization Name:MERCY LIFE CENTER CORPORATION
Other - Org Name:MERCY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFFAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-323-4519
Mailing Address - Street 1:1200 REEDSDALE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2109
Mailing Address - Country:US
Mailing Address - Phone:412-323-8026
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:1200 REEDSDALE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-2109
Practice Address - Country:US
Practice Address - Phone:412-323-8026
Practice Address - Fax:412-323-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA550856OtherKHPW
PA1000042540127Medicaid
PA1000042540127Medicaid
PA550856OtherKHPW