Provider Demographics
NPI:1922349075
Name:CONEMAUGH VALLEY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CONEMAUGH VALLEY MEMORIAL HOSPITAL
Other - Org Name:CONEMAUGH COUNSELING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PFS
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DZIAGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-410-8296
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8296
Mailing Address - Fax:814-410-8495
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1601
Practice Address - Country:US
Practice Address - Phone:814-410-8296
Practice Address - Fax:814-410-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA330390273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100756849Medicaid
39S110Medicare Oscar/Certification