Healthcare Provider Details

I. General information

NPI: 1164583050
Provider Name (Legal Business Name): MON YOUGH COMMUNITY SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SHAW AVE APT 7
MCKEESPORT PA
15132-3301
US

IV. Provider business mailing address

500 WALNUT ST 3RD FLOOR
MCKEESPORT PA
15132
US

V. Phone/Fax

Practice location:
  • Phone: 412-673-4419
  • Fax: 412-675-8420
Mailing address:
  • Phone: 412-675-8533
  • Fax: 412-675-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NOREEN FREDERICK
Title or Position: CEO
Credential:
Phone: 412-673-8035