Provider Demographics
NPI:1558380469
Name:CONNEAUT VALLEY HEALTH CENTER INC.
Entity Type:Organization
Organization Name:CONNEAUT VALLEY HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUNTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-373-2449
Mailing Address - Street 1:1009 WATER ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3465
Mailing Address - Country:US
Mailing Address - Phone:814-373-2449
Mailing Address - Fax:814-373-3050
Practice Address - Street 1:906 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONNEAUTVILLE
Practice Address - State:PA
Practice Address - Zip Code:16406
Practice Address - Country:US
Practice Address - Phone:814-373-2276
Practice Address - Fax:814-587-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011018L207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007230030001Medicaid
PACE7746OtherRAIL ROAD MEDICARE
PA191386OtherHIGHMARK BC/BS
PA191386OtherHIGHMARK BC/BS
PA0007230030001Medicaid