1326176546 NPI number — TURTLE CREEK VALLEY MH MR INC

Table of content: (NPI 1326176546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326176546 NPI number — TURTLE CREEK VALLEY MH MR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TURTLE CREEK VALLEY MH MR INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326176546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
723 BRADDOCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADDOCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15104-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-351-0222
Provider Business Mailing Address Fax Number:
412-351-2616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 S 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15203-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-381-2100
Provider Business Practice Location Address Fax Number:
412-381-2004
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEDY BOST
Authorized Official First Name:
FRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
412-351-0222

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  707082 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111270 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760666 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 648025 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007281380036 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340652 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: IG001416 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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