Provider Demographics
NPI:1558482901
Name:COMMUNITY GUIDANCE CENTER
Entity Type:Organization
Organization Name:COMMUNITY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-465-5576
Mailing Address - Street 1:793 OLD ROUTE 119 HWY N
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1372
Mailing Address - Country:US
Mailing Address - Phone:724-465-5576
Mailing Address - Fax:724-463-3262
Practice Address - Street 1:793 OLD ROUTE 119 HWY N
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1372
Practice Address - Country:US
Practice Address - Phone:724-465-5576
Practice Address - Fax:724-463-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000033280035Medicaid