Clearfield-Jefferson MHMR Program
Organization Active NPI Case Management Agency · Brockway, PA
NPI 1497819031 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1497819031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Case Management Agency 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 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Colette Dushac
- Title
- Administrator
- Phone
- (814) 265-1060
Corporate family (same tax ID) 3
National Provider Directory
- Tax ID family
- Clearfield-Jefferson MHMR Program
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007332450003 | Medicaid | PA |
Other providers in Brockway, PA
- Brockway Family Practice LLC
- Matthew T Carroll
- Clearfield-Jefferson MHMR Program
- Clearfield-Jefferson MHMR Program
- Clearfield-Jefferson MHMR Program
- Casie Jonel Costion
- Joan Elizabeth Crawford
- James Edward Devlin
- Amy Diaz
- Dubois Regional Medical Center
All providers in Brockway, PA · Case Management Agency in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.