Provider Demographics
NPI:1477684264
Name:DEERFIELD BEHAVIORAL HEALTH OF WARREN
Entity Type:Organization
Organization Name:DEERFIELD BEHAVIORAL HEALTH OF WARREN
Other - Org Name:DEERFIELD CENTERS FOR ADDICTIONS TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX DIR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-723-5545
Mailing Address - Street 1:1003 PENNSYLVANIA AVE W FL 2
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1876
Mailing Address - Country:US
Mailing Address - Phone:814-723-5545
Mailing Address - Fax:814-362-5245
Practice Address - Street 1:CHESTNUT STREET
Practice Address - Street 2:MARIENVILLE MEDICAL CENTER
Practice Address - City:MARIENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16239
Practice Address - Country:US
Practice Address - Phone:888-893-3228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA627026261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0828OtherHIGHMARK BLUE CROSS
PA330194OtherVALUE OPTIONS
PA0015930840010Medicaid