Healthcare Provider Details

I. General information

NPI: 1083982599
Provider Name (Legal Business Name): MERCY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 9TH ST
PITTSBURGH PA
15203-1266
US

IV. Provider business mailing address

1200 REEDSDALE ST
PITTSBURGH PA
15233-2109
US

V. Phone/Fax

Practice location:
  • Phone: 412-488-4040
  • Fax:
Mailing address:
  • Phone: 412-323-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCW013707
License Number StatePA

VIII. Authorized Official

Name: MR. CRAIG DOUGLASS
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 41232344543