Healthcare Provider Details

I. General information

NPI: 1649464769
Provider Name (Legal Business Name): PASSAVANT MEMORIAL HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASSAVANT WAY
PITTSBURGH PA
15238-1318
US

IV. Provider business mailing address

100 PASSAVANT WAY
PITTSBURGH PA
15238-1318
US

V. Phone/Fax

Practice location:
  • Phone: 412-820-1010
  • Fax: 412-820-1025
Mailing address:
  • Phone: 412-820-1010
  • Fax: 412-820-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number439240
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number465150
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number409250
License Number StatePA

VIII. Authorized Official

Name: MICHELLE BROWN
Title or Position: UTILIZATION COORDINATOR
Credential:
Phone: 412-820-1010