Basic Information
| Provider Information | |||||||||
| NPI: | 1912942780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TURTLE CREEK VALLEY MENTAL HEALTH MENTAL RETARDATION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151041849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123510222 | ||||||||
| FaxNumber: | 4123512616 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 BRADDOCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRADDOCK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151041849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123510222 | ||||||||
| FaxNumber: | 4123512616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHEEDY BOST | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4123510222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | 422510 | PA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 001760666 | 01 | HIGHMARK | OTHER | 1007281380054 | 05 | PA | MEDICAID | 648025 | 01 | HIGHMARK | OTHER | IG001416 | 01 | MAGELLAN | OTHER | CN3397 | 01 | RAILROAD MEDICARE | OTHER | 111270 | 01 | VALUE OPTIONS | OTHER |