Healthcare Provider Details

I. General information

NPI: 1306184775
Provider Name (Legal Business Name): CPP BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2013
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N GALLATIN AVE
UNIONTOWN PA
15401-2969
US

IV. Provider business mailing address

180 N GALLATIN AVE
UNIONTOWN PA
15401-2969
US

V. Phone/Fax

Practice location:
  • Phone: 724-550-4343
  • Fax:
Mailing address:
  • Phone: 724-550-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number444760
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number444760
License Number StatePA

VIII. Authorized Official

Name: MR. GREGORY PONKO
Title or Position: CFO
Credential:
Phone: 724-550-4343