Provider Demographics
NPI:1518168368
Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Entity Type:Organization
Organization Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-451-2225
Mailing Address - Street 1:1330 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1330 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1402
Practice Address - Country:US
Practice Address - Phone:814-459-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007511360026Medicaid
PA1007511360027Medicaid
PA1007511360028Medicaid
PA1007511360016Medicaid