NPIMap

Organization Active NPI

Saint Vincent Serenity Program

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Erie, PA
National Provider Identifier
1184797961
Registry record updated Jun 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
252013 Issued in PA
Legal business name
SAINT VINCENT SERENITY PROGRAM
Practice address
1910 Sassafras St
Suite 100
Erie, PA 16502-2716
Phone
(814) 452-5555
NPI assigned
Nov 17, 2006
Last updated
Jun 8, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
SAINT VINCENT HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2011

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

Authorized official

Name
Mr. Scott A Whalen, PHD, FACHE
Title
President & Ceo
Phone
(814) 452-5111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 252013 PA Primary

Addresses

Primary practice location

1910 Sassafras St
Suite 100
Erie, PA 16502-2716

Mailing address

1910 Sassafras St
Suite 100
Erie, PA 16502-2716
Phone (814) 452-5555

Other identifiers 2

IdentifierTypeStateIssuer
100162500039MedicaidPA
0801OtherPAHIGHMARK FACILITY NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Saint Vincent Health Ce11 organizations share this tax ID, including this one
Part of
Saint Vincent Health Ce

Other organizations with this tax ID 10

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": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1184797961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 SASSAFRAS ST",
            "address_2": "SUITE 100",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022716",
            "telephone_number": "814-452-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 SASSAFRAS ST",
            "address_2": "SUITE 100",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022716",
            "telephone_number": "814-452-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT VINCENT SERENITY PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT VINCENT HEALTH CENTER",
        "enumeration_date": "2006-11-17",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "WHALEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "814-452-5111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD, FACHE"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PA",
            "license": "252013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100162500039",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK FACILITY NUMBER",
            "identifier": "0801",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.