Provider Demographics
NPI:1982724548
Name:STAIRWAYS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:STAIRWAYS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-453-5806
Mailing Address - Street 1:138 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1049
Mailing Address - Country:US
Mailing Address - Phone:814-453-5806
Mailing Address - Fax:814-453-4757
Practice Address - Street 1:106 E 29TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1052
Practice Address - Country:US
Practice Address - Phone:814-453-5806
Practice Address - Fax:814-453-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA401360261Q00000X
PA425610261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000063480019Medicaid