Basic Information
Provider Information | |||||||||
NPI: | 1255406393 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UPMC BEHAVIORAL HEALTH OF THE ALLEGHENIES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 500 E CHESTNUT AVE | ||||||||
Address2: |   | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166015215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149407457 | ||||||||
FaxNumber: | 8145691019 | ||||||||
Practice Location | |||||||||
Address1: | 500 E CHESTNUT AVE | ||||||||
Address2: | D&A OP | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166015215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149430414 | ||||||||
FaxNumber: | 8149436198 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/22/2006 | ||||||||
LastUpdateDate: | 11/02/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHUFF | ||||||||
AuthorizedOfficialFirstName: | MARK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR, BEHAVIORAL HEAL | ||||||||
AuthorizedOfficialTelephone: | 8149407457 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 077013 | PA | N |   | Ambulatory Health Care Facilities | Clinic/Center |   | 261QM0801X | 077013 | PA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | 077013 | PA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 077013 | PA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | 077013 | PA | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 1000007650010 | 05 | PA |   | MEDICAID | 1652320 | 01 | PA | HIGHMARK BLUE CARED | OTHER | 114514 | 01 | PA | VALUE OPTIONS | OTHER | 263087 | 01 | PA | HIGHMARK AND BLUE SHIELD | OTHER | 1000007650048 | 05 | PA |   | MEDICAID |