Provider Demographics
NPI:1245695840
Name:CAMBRIA COUNTY BH/ID/EI
Entity type:Organization
Organization Name:CAMBRIA COUNTY BH/ID/EI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELAK
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:814-534-2721
Mailing Address - Street 1:110 FRANKLIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1830
Mailing Address - Country:US
Mailing Address - Phone:814-535-8531
Mailing Address - Fax:814-539-8440
Practice Address - Street 1:110 FRANKLIN ST STE 300
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1830
Practice Address - Country:US
Practice Address - Phone:814-535-8531
Practice Address - Fax:814-539-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health