Provider Demographics
NPI:1750677696
Name:GREATER READING MENTAL HEALTH ALLIANCE
Entity Type:Organization
Organization Name:GREATER READING MENTAL HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-775-3000
Mailing Address - Street 1:1234 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2130
Mailing Address - Country:US
Mailing Address - Phone:610-775-3000
Mailing Address - Fax:610-775-4000
Practice Address - Street 1:1234 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2130
Practice Address - Country:US
Practice Address - Phone:610-775-3000
Practice Address - Fax:610-775-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261Q00000X261Q00000X
PA261QM0801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026170300001Medicaid