Provider Demographics
NPI:1942582333
Name:ARMSTRONG-INDIANA BEHAVIORAL AND DEVELOPMENTAL HEALTH PROGRAM
Entity Type:Organization
Organization Name:ARMSTRONG-INDIANA BEHAVIORAL AND DEVELOPMENTAL HEALTH PROGRAM
Other - Org Name:ARMSTRONG-INDIANA MENTAL HEALTH/MENTAL RETARDATION PROGRAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:724-548-3451
Mailing Address - Street 1:124 ARMSDALE RD
Mailing Address - Street 2:ARMSDALE ADMINISTRATION BUILDING SUITE 105
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-3738
Mailing Address - Country:US
Mailing Address - Phone:724-548-3451
Mailing Address - Fax:724-548-3454
Practice Address - Street 1:124 ARMSDALE RD
Practice Address - Street 2:ARMSDALE ADMINISTRATION BUILDING SUITE 105
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-3738
Practice Address - Country:US
Practice Address - Phone:724-548-3451
Practice Address - Fax:724-548-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA441480251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102215347OtherPROMISE ID