Provider Demographics
NPI:1548381981
Name:CLEARFIELD-JEFFERSON CMHC
Entity Type:Organization
Organization Name:CLEARFIELD-JEFFERSON CMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPRVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORSHA
Authorized Official - Suffix:
Authorized Official - Credentials:B S EDUCATION
Authorized Official - Phone:814-371-1100
Mailing Address - Street 1:100 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1152
Mailing Address - Country:US
Mailing Address - Phone:814-371-1100
Mailing Address - Fax:814-371-3671
Practice Address - Street 1:100 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1152
Practice Address - Country:US
Practice Address - Phone:814-371-1100
Practice Address - Fax:814-371-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA413980251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007627390030Medicaid