Healthcare Provider Details

I. General information

NPI: 1558380469
Provider Name (Legal Business Name): CONNEAUT VALLEY HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 WASHINGTON ST
CONNEAUTVILLE PA
16406
US

IV. Provider business mailing address

1009 WATER ST SECOND FLOOR
MEADVILLE PA
16335-3465
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-2276
  • Fax: 814-587-2918
Mailing address:
  • Phone: 814-373-2449
  • Fax: 814-373-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS011018L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberOS011018L
License Number StatePA

VIII. Authorized Official

Name: MR. RENATO J. SUNTAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 814-373-2449