Mistyisle Bridge. Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

424960 Issued in PA

Legal business name

MISTYISLE BRIDGE. INC

Practice address

9664 Route 322
Shippenville, PA 16254-8734

Phone

(814) 226-1153

Fax

(814) 226-1156

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Terrance Bean

Title

President

Phone

(814) 226-1153

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255564800000",
    "number": "1487784146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 605",
            "city": "CLARION",
            "state": "PA",
            "postal_code": "162140605",
            "telephone_number": "814-226-1153",
            "fax_number": "814-226-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9664 ROUTE 322",
            "city": "SHIPPENVILLE",
            "state": "PA",
            "postal_code": "162548734",
            "telephone_number": "814-226-1153",
            "fax_number": "814-226-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTYISLE BRIDGE. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2009-10-15",
        "status": "A",
        "authorized_official_last_name": "BEAN",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-226-1153",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "424960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012740580001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Kunselman, D.O.
• Danielle M Leach, MS, MSW, LSW
• Courtney Lyn Lewis, CCC-SLP
• Brenton Vaughn Long, D.O.
• Brenda Arlene Manno, MSW LSW
• Derek Francis Oberlander
• Jennifer Pappas
• Melissa Sue Pore, CCC/SLP
• Project Starphish
• Qpharma Inc

• Community/Behavioral Health Agency in Shippenville, PA
• Providers in Shippenville, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; 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.