Healthcare Provider Details

I. General information

NPI: 1275253734
Provider Name (Legal Business Name): MORIAH BEHAVIORAL HEALTH CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 03/27/2024
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 LONE MESA DR
LAS VEGAS NV
89147-6814
US

IV. Provider business mailing address

512 NORTHAMPTON ST # 158
EDWARDSVILLE PA
18704-4560
US

V. Phone/Fax

Practice location:
  • Phone: 725-272-0330
  • Fax:
Mailing address:
  • Phone: 570-203-9222
  • Fax: 570-203-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MARSHALL
Title or Position: DIRECTOR, BILLING & COLLECTIONS
Credential:
Phone: 570-203-9222