Healthcare Provider Details

I. General information

NPI: 1518001601
Provider Name (Legal Business Name): TURTLE CREEK VALLEY MH MR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 PENN AVE HUMAN SERVICES CENTER
TURTLE CREEK PA
15145
US

IV. Provider business mailing address

723 BRADDOCK AVE
BRADDOCK PA
15104-1849
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-8510
  • Fax: 412-824-0948
Mailing address:
  • Phone: 412-351-0222
  • Fax: 412-351-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number422510
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number422510
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number422510
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007281380050
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1760666
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHARK
# 3
Identifier648025
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK
# 4
Identifier111270
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS
# 5
IdentifierCN3397
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier1007281380017
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 7
Identifier1040548
Identifier TypeOTHER
Identifier State
Identifier IssuerGATEWAY HEALTH PLAN MEDICARE ASSURED
# 8
Identifier1760672
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK
# 9
Identifier340652
Identifier TypeOTHER
Identifier State
Identifier IssuerTRICARE CHAMPUS
# 10
IdentifierIG001416
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN

VIII. Authorized Official

Name: FRAN SHEEDY BOST
Title or Position: EXECUTIVE DIRECTOR
Credential: MED
Phone: 412-351-0222