Healthcare Provider Details

I. General information

NPI: 1437400751
Provider Name (Legal Business Name): COMMUNITY RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 1/2 4TH ST
MONONGAHELA PA
15063-1970
US

IV. Provider business mailing address

1360 1/2 4TH ST
MONONGAHELA PA
15063-1970
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-2934
  • Fax: 724-258-2936
Mailing address:
  • Phone: 724-258-2934
  • Fax: 724-258-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number433901
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. GARRY MCGRATH
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MPA
Phone: 412-298-7778