NPIMap

Organization Active NPI

Clearfield-Jefferson CMHC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Du Bois, PA
National Provider Identifier
1427170380
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
425110 Issued in PA
Legal business name
CLEARFIELD-JEFFERSON CMHC
Practice address
404 Liberty Blvd
Du Bois, PA 15801-2436
Phone
(814) 371-1100
Fax
(814) 371-3671
NPI assigned
Apr 4, 2007
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
Karen H Forsha, B. S. EDUCATION
Title
Billing Supervisor
Phone
(814) 371-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 425110 PA Primary

Addresses

Primary practice location

404 Liberty Blvd
Du Bois, PA 15801-2436

Mailing address

100 Caldwell Dr
Du Bois, PA 15801-1152
Phone (814) 371-1100

Other identifiers 1

IdentifierTypeStateIssuer
1007627390066MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Clearfield-Jefferson CMHC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

404 Liberty Blvd
Du Bois, PA 15801
Phone (814) 375-8776

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427170380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CALDWELL DR",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011152",
            "telephone_number": "814-371-1100",
            "fax_number": "814-371-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 LIBERTY BLVD",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158012436",
            "telephone_number": "814-371-1100",
            "fax_number": "814-371-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARFIELD-JEFFERSON CMHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORSHA",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "814-371-1100",
        "authorized_official_credential": "B. S. EDUCATION"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PA",
            "license": "425110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007627390066",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, 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.