=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023438082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY BEHAVIORAL RESOURCES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2014
-----------------------------------------------------
Last Update Date | 04/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W HIGH ST STE 209
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-419-8046
-----------------------------------------------------
Fax | 814-419-8274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 879
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-0879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-850-1750
-----------------------------------------------------
Fax | 724-420-5318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR OF CLINICAL & BUSINESS SYSTEMS
-----------------------------------------------------
Name | KAREN FRIDG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-850-1750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 422020
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------