Healthcare Provider Details

I. General information

NPI: 1649448366
Provider Name (Legal Business Name): TURTLE CREEK VALLEY MH/MR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 PENN AVE HUMAN SERVICES CENTER
TURTLE CREEK PA
15145-2082
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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number422510
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number422510
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007281380021
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007281380064
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. JUDY MONAHAN GRYSTAR
Title or Position: EXECUTIVE DIRECTOR
Credential: LSW
Phone: 412-351-0222