Healthcare Provider Details

I. General information

NPI: 1992925689
Provider Name (Legal Business Name): CLARION COUNTY MENTAL RETARDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S 7TH AVE
CLARION PA
16214-2053
US

IV. Provider business mailing address

214 S 7TH AVE
CLARION PA
16214-2053
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-1080
  • Fax: 814-226-1157
Mailing address:
  • Phone: 814-226-1080
  • Fax: 814-226-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARY JO RHODE
Title or Position: DEPUTY ADMINISTRATOR
Credential:
Phone: 814-226-1080