Provider Demographics
NPI:1740310176
Name:DEERFIELD BEHAVIORAL HEALTH OF WARREN
Entity type:Organization
Organization Name:DEERFIELD BEHAVIORAL HEALTH OF WARREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EX DIR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-723-5545
Mailing Address - Street 1:1003 PENNSYLVANIA AVE W FL 2
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1876
Mailing Address - Country:US
Mailing Address - Phone:814-723-5545
Mailing Address - Fax:814-362-5245
Practice Address - Street 1:115 W SPRING ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1763
Practice Address - Country:US
Practice Address - Phone:814-827-3467
Practice Address - Fax:814-827-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207012261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA330194OtherVALUE OPTIONS
PA0015930840013Medicaid
PA0828OtherHIGHMARK BLUE CROSS