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General NPI Number Information
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NPI Number | 1659549442
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Entity Type | Organization
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Legal Business Name | THRESHOLD, INC.
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 111 TRIDICO WAY
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City | GREENSBURG
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State | PA
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Zip | 15601-2627
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Country | US
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Telephone | 724-837-9348
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Fax | 724-837-8044
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Provider Business Mailing Address
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Address Line | 111 TRIDICO WAY
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City | GREENSBURG
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State | PA
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Zip | 15601-2627
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Country | US
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Telephone | 724-837-9348
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Fax | 724-837-8044
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JEAN WIGLE
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Credential |
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Telephone | 724-837-9348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 426090
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License Number State | PA
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