NPIMap

Organization Active NPI

Clearfield-Jefferson MHMR Program

  • Case Management Agency
  • Brockway, PA
National Provider Identifier
1053476879
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
CLEARFIELD-JEFFERSON MHMR PROGRAM
Practice address
1200 Wood St Ste U110
Brockway, PA 15824-2118
Phone
(814) 265-1060
Fax
(814) 265-1049
NPI assigned
Dec 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Colette Dushac
Title
Administrator
Phone
(814) 265-1060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU Primary

Addresses

Primary practice location

1200 Wood St Ste U110
Brockway, PA 15824-2118

Mailing address

1200 Wood St Ste U110
Brockway, PA 15824-2118
Phone (814) 265-1060

Other identifiers 1

IdentifierTypeStateIssuer
1007332450006MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Clearfield-Jefferson MHMR Program4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053476879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WOOD ST STE U110",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158242118",
            "telephone_number": "814-265-1060",
            "fax_number": "814-265-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WOOD ST STE U110",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158242118",
            "telephone_number": "814-265-1060",
            "fax_number": "814-265-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARFIELD-JEFFERSON MHMR PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUSHAC",
        "authorized_official_first_name": "COLETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "814-265-1060"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007332450006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockway, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.