Provider Demographics
NPI:1689853103
Name:THREE RIVERS ADOPTION COUNCIL
Entity Type:Organization
Organization Name:THREE RIVERS ADOPTION COUNCIL
Other - Org Name:TRAC SERVICES FOR FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:412-471-8722
Mailing Address - Street 1:1600 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-1031
Mailing Address - Country:US
Mailing Address - Phone:412-471-8722
Mailing Address - Fax:412-471-4861
Practice Address - Street 1:1600 W CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-1031
Practice Address - Country:US
Practice Address - Phone:412-471-8722
Practice Address - Fax:412-471-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1932355351Medicaid
PA1689853103Medicaid