Healthcare Provider Details

I. General information

NPI: 1902889876
Provider Name (Legal Business Name): PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MAYVIEW RD
BRIDGEVILLE PA
15017-1547
US

IV. Provider business mailing address

1601 MAYVIEW RD
BRIDGEVILLE PA
15017-1547
US

V. Phone/Fax

Practice location:
  • Phone: 412-257-6226
  • Fax: 412-257-6808
Mailing address:
  • Phone: 412-257-6226
  • Fax: 412-257-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: LINDA WYLIE
Title or Position: CEO
Credential:
Phone: 412-257-6226