Provider Demographics
NPI:1134267214
Name:JUNIATA COMMUNITY MENTAL HEALTH
Entity type:Organization
Organization Name:JUNIATA COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-291-0550
Mailing Address - Street 1:2637-45 N. 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-0000
Mailing Address - Country:US
Mailing Address - Phone:215-291-0550
Mailing Address - Fax:215-291-0566
Practice Address - Street 1:2637-45 N. 5TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-0000
Practice Address - Country:US
Practice Address - Phone:215-291-0550
Practice Address - Fax:215-291-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111780261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011504260003Medicaid