Healthcare Provider Details

I. General information

NPI: 1427133248
Provider Name (Legal Business Name): CONNEAUT VALLEY HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10926 HIGHWAY 18
CONNEAUT LAKE PA
16316-3526
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-382-0446
  • Fax: 814-382-7386
Mailing address:
  • Phone: 814-373-2449
  • Fax: 814-373-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberOS011018L
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL DOWNING
Title or Position: CEO
Credential:
Phone: 814-373-2449