Provider Demographics
NPI:1679730592
Name:MENTAL HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-225-2061
Mailing Address - Street 1:15 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4821
Mailing Address - Country:US
Mailing Address - Phone:724-225-2061
Mailing Address - Fax:724-225-4770
Practice Address - Street 1:225 SPRING ST
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1252
Practice Address - Country:US
Practice Address - Phone:724-239-3993
Practice Address - Fax:724-239-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA424660320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA582217OtherVALUE OPTIONS PROVIDER NUMBER
PA101722148 0004OtherPROMISE ID