Healthcare Provider Details

I. General information

NPI: 1558367185
Provider Name (Legal Business Name): BEDFORD SOMERSET DEVELOPMENTAL AND BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W RACE ST
SOMERSET PA
15501-1922
US

IV. Provider business mailing address

245 W RACE ST
SOMERSET PA
15501-1922
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-4891
  • Fax: 814-443-4898
Mailing address:
  • Phone: 814-443-4891
  • Fax: 814-443-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number123535
License Number StatePA

VIII. Authorized Official

Name: MS. JENNIFER ELAINE SMITH
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 814-443-4891