Provider Demographics
NPI:1609910769
Name:TURTLE CREEK VALLEY MENTAL HEALTH MENTAL RETARDATION INC
Entity Type:Organization
Organization Name:TURTLE CREEK VALLEY MENTAL HEALTH MENTAL RETARDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEDY BOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-351-0222
Mailing Address - Street 1:723 BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1849
Mailing Address - Country:US
Mailing Address - Phone:412-351-0222
Mailing Address - Fax:412-351-2616
Practice Address - Street 1:1800 WEST ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-2578
Practice Address - Country:US
Practice Address - Phone:412-462-9901
Practice Address - Fax:412-462-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422510251S00000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007281380051Medicaid
IG001416OtherMAGELLAN
PA1040548OtherGATEWAY HEALTH PLAN MEDICARE ASSURED
17606666OtherHIGHMARK
1760672OtherHIGHMARK
648025OtherHIGHMARK
PA1007281380029Medicaid
111270OtherVALUE OPTIONS
340652OtherTRICARE CAMPUS
394680Medicare Oscar/Certification
17606666OtherHIGHMARK
PA1007281380029Medicaid