Healthcare Provider Details

I. General information

NPI: 1912942780
Provider Name (Legal Business Name): TURTLE CREEK VALLEY MENTAL HEALTH MENTAL RETARDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 BRADDOCK AVE
BRADDOCK PA
15104-1849
US

IV. Provider business mailing address

723 BRADDOCK AVE
BRADDOCK PA
15104-1849
US

V. Phone/Fax

Practice location:
  • Phone: 412-351-0222
  • Fax: 412-351-2616
Mailing address:
  • Phone: 412-351-0222
  • Fax: 412-351-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number422510
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001760666
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK
# 2
Identifier1007281380054
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier648025
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK
# 4
IdentifierIG001416
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN
# 5
IdentifierCN3397
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier111270
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS

VIII. Authorized Official

Name: FRANCES SHEEDY BOST
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 412-351-0222