Healthcare Provider Details

I. General information

NPI: 1669478764
Provider Name (Legal Business Name): MON YOUGH COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SHAW AVE
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

500 WALNUT ST 3RD FL
MCKEESPORT PA
15132-2801
US

V. Phone/Fax

Practice location:
  • Phone: 413-675-8530
  • Fax: 412-675-8533
Mailing address:
  • Phone: 412-675-8530
  • Fax: 412-675-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier648059
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BC/BS
# 2
Identifier100000980
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CATHERINE CONROY
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 412-675-8533