Healthcare Provider Details

I. General information

NPI: 1821502410
Provider Name (Legal Business Name): MARIGOLD TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 WASHINGTON AVE
BRIDGEVILLE PA
15017-2332
US

IV. Provider business mailing address

316 STATION ST STE 300
BRIDGEVILLE PA
15017-1830
US

V. Phone/Fax

Practice location:
  • Phone: 412-221-1090
  • Fax:
Mailing address:
  • Phone: 412-221-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KEATLEY
Title or Position: MEMBER
Credential:
Phone: 412-221-1091