Provider Demographics
NPI:1649448366
Name:TURTLE CREEK VALLEY MH/MR, INC.
Entity type:Organization
Organization Name:TURTLE CREEK VALLEY MH/MR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHAN GRYSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:412-351-0222
Mailing Address - Street 1:723 BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1849
Mailing Address - Country:US
Mailing Address - Phone:412-351-0222
Mailing Address - Fax:412-351-2616
Practice Address - Street 1:519 PENN AVE
Practice Address - Street 2:HUMAN SERVICES CENTER
Practice Address - City:TURTLE CREEK
Practice Address - State:PA
Practice Address - Zip Code:15145-2082
Practice Address - Country:US
Practice Address - Phone:412-824-8510
Practice Address - Fax:412-824-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422510261QM0855X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007281380021Medicaid
PA1007281380064Medicaid