Provider Demographics
NPI:1720075104
Name:MERCY LIFE CENTER CORPORATION
Entity Type:Organization
Organization Name:MERCY LIFE CENTER CORPORATION
Other - Org Name:MERCY BEHAVORIAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-323-4564
Mailing Address - Street 1:1200 REEDSDALE ST
Mailing Address - Street 2:MERCY BEHAVORIAL HEALTH
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2109
Mailing Address - Country:US
Mailing Address - Phone:412-697-0712
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:1200 REEDSDALE ST
Practice Address - Street 2:MERCY BEHAVORIAL HEALTH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-2109
Practice Address - Country:US
Practice Address - Phone:412-323-4543
Practice Address - Fax:412-323-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000042540173Medicaid
PA1000042540112Medicaid
PA1000042540127Medicaid
PA1000042540090Medicaid
550856OtherHIGH MARK MGD CARE
550856OtherHIGH MARK MGD CARE
PA1000042540090Medicaid
PA1000042540112Medicaid
PA1000042540127Medicaid