Provider Demographics
NPI:1245699313
Name:PASSAVANT MEMORIAL HOMES
Entity type:Organization
Organization Name:PASSAVANT MEMORIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-820-1010
Mailing Address - Street 1:100 PASSAVANT WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1318
Mailing Address - Country:US
Mailing Address - Phone:412-820-1010
Mailing Address - Fax:
Practice Address - Street 1:1016 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3747
Practice Address - Country:US
Practice Address - Phone:412-820-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA441200320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities