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General NPI Number Information
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NPI Number | 1205101557
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Entity Type | Organization
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Legal Business Name | MYAH'S HOUSE OF HOPE
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 500 3RD AVE BOX 392
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City | FORD CITY
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State | PA
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Zip | 16226-1004
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Country | US
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Telephone | 724-763-1323
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Fax | 724-788-1326
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Provider Business Mailing Address
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Address Line | BOX 392 500 3RD AVE
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City | FORD CITY
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State | PA
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Zip | 15001
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Country | US
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Telephone | 724-763-1323
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SELENNA G. MORELAND
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Credential |
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Telephone | 724-203-4669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 037024
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License Number State | PA
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