Healthcare Provider Details

I. General information

NPI: 1891815429
Provider Name (Legal Business Name): STAIRWAYS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16332 CONNEAUT LAKE RD
MEADVILLE PA
16335-3843
US

IV. Provider business mailing address

138 E 26TH ST
ERIE PA
16504-1049
US

V. Phone/Fax

Practice location:
  • Phone: 814-337-8762
  • Fax: 814-337-4462
Mailing address:
  • Phone: 814-453-5806
  • Fax: 814-453-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number405900
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number405900
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number405900
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number405900
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40590
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number405900
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS KIRKWOOD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 814-453-5806