Provider Demographics
NPI:1467648709
Name:MAMA'S HOUSE P.C.H.
Entity Type:Organization
Organization Name:MAMA'S HOUSE P.C.H.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MSW
Authorized Official - Phone:412-217-9026
Mailing Address - Street 1:142 ELM ST.
Mailing Address - Street 2:P.O. BOX 494
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323
Mailing Address - Country:US
Mailing Address - Phone:724-663-4284
Mailing Address - Fax:724-663-4284
Practice Address - Street 1:142 ELM ST.
Practice Address - Street 2:
Practice Address - City:CLAYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15323
Practice Address - Country:US
Practice Address - Phone:724-663-4284
Practice Address - Fax:724-663-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA400630310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness