Provider Demographics
NPI:1205101557
Name:MYAH'S HOUSE OF HOPE
Entity type:Organization
Organization Name:MYAH'S HOUSE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELENNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-203-4669
Mailing Address - Street 1:BOX 392
Mailing Address - Street 2:500 3RD AVE
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15001
Mailing Address - Country:US
Mailing Address - Phone:724-763-1323
Mailing Address - Fax:
Practice Address - Street 1:500 3RD AVE
Practice Address - Street 2:BOX 392
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1004
Practice Address - Country:US
Practice Address - Phone:724-763-1323
Practice Address - Fax:724-788-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037024324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility