Healthcare Provider Details

I. General information

NPI: 1912626433
Provider Name (Legal Business Name): MORIAH BEHAVIORAL HEALTH CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 BAHAMA BAY CT
LAS VEGAS NV
89147-6800
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 TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
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