Provider Demographics
NPI:1619639226
Name:BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH INTEGRATIVE CARE OF PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. OPS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-473-9426
Mailing Address - Street 1:1170 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2601
Mailing Address - Country:US
Mailing Address - Phone:305-542-0687
Mailing Address - Fax:
Practice Address - Street 1:2214 N ATHERTON ST STE 3-6
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1544
Practice Address - Country:US
Practice Address - Phone:305-542-0687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder