Provider Demographics
NPI:1841432184
Name:WESTERN PA BEHAVIORAL HEALTH RESOURCES
Entity Type:Organization
Organization Name:WESTERN PA BEHAVIORAL HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-785-4346
Mailing Address - Street 1:6381 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:GRINDSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:15442-1190
Mailing Address - Country:US
Mailing Address - Phone:724-785-4346
Mailing Address - Fax:724-364-7117
Practice Address - Street 1:6381 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1190
Practice Address - Country:US
Practice Address - Phone:724-785-4346
Practice Address - Fax:724-364-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423515261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020795770004Medicaid
PA150273Medicare PIN