Basic Information
| Provider Information | |||||||||
| NPI: | 1619275898 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UPMC BEHAVIORAL HEALTH OF THE ALLEGHENIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E CHESTNUT AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166015215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149407457 | ||||||||
| FaxNumber: | 8145691019 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LAKEMONT PARK BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166025945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149460261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHUFF | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR, BEHAVIORAL HEAL | ||||||||
| AuthorizedOfficialTelephone: | 8149407457 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 1000007650050 | 05 | PA | MEDICAID |