Healthcare Provider Details

I. General information

NPI: 1538213657
Provider Name (Legal Business Name): MEADVILLE MEDICAL CENTER OUTPATIENT DRUG AND ALCOHOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

IV. Provider business mailing address

1034 GROVE ST CBO
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5810
  • Fax: 814-333-5817
Mailing address:
  • Phone: 814-373-2923
  • Fax: 814-333-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: RENATO SUNTAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 814-333-5031