Healthcare Provider Details

I. General information

NPI: 1588856587
Provider Name (Legal Business Name): COMMUNITY GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 N MAIN ST STE 1
PUNXSUTAWNEY PA
15767-2609
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY N
INDIANA PA
15701-1372
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-4444
  • Fax: 724-463-3262
Mailing address:
  • Phone: 724-465-5576
  • Fax: 724-463-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1000033280038
License Number StatePA

VIII. Authorized Official

Name: KAREN H. FORSHA
Title or Position: BILLING SUPERVISOR
Credential: B.S. ED.
Phone: 724-465-5576