Provider Demographics
NPI:1619949948
Name:CHILDRENS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CHILDRENS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-262-0768
Mailing Address - Street 1:1001 BROAD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-2437
Mailing Address - Country:US
Mailing Address - Phone:814-262-0768
Mailing Address - Fax:814-262-0795
Practice Address - Street 1:1001 BROAD ST STE 210
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2437
Practice Address - Country:US
Practice Address - Phone:814-262-0768
Practice Address - Fax:814-262-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA302310251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA561494OtherVALUE BEHAVIORAL HEALTH
PA101273408Medicaid
PAVC0572Medicaid
PA100749414Medicaid