Provider Demographics
NPI:1740404813
Name:BEAVER COUNTY MH MR - D&A PROGRAM
Entity Type:Organization
Organization Name:BEAVER COUNTY MH MR - D&A PROGRAM
Other - Org Name:BEAVER COUNTY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-847-6225
Mailing Address - Street 1:1040 8TH AVE
Mailing Address - Street 2:HUMAN SERVICE BUILDING, FLOOR 2
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4506
Mailing Address - Country:US
Mailing Address - Phone:724-847-6225
Mailing Address - Fax:724-891-2865
Practice Address - Street 1:1040 8TH AVE
Practice Address - Street 2:HUMAN SERVICE BUILDING, FLOOR 2
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4506
Practice Address - Country:US
Practice Address - Phone:724-847-6225
Practice Address - Fax:724-891-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007583980007Medicaid
PA1007583980027Medicaid