Provider Demographics
NPI:1891815429
Name:STAIRWAYS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:STAIRWAYS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-453-5806
Mailing Address - Street 1:138 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1049
Mailing Address - Country:US
Mailing Address - Phone:814-453-5806
Mailing Address - Fax:814-453-4757
Practice Address - Street 1:16332 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3843
Practice Address - Country:US
Practice Address - Phone:814-337-8762
Practice Address - Fax:814-337-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA405900101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 261Q00000X
PA405902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000063480024Medicaid
PA410887Medicare ID - Type Unspecified