=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669500872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TURTLE CREEK VALLEY MH MR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 06/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 HARTMAN ST
-----------------------------------------------------
City | MCKEESPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15132-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-673-5800
-----------------------------------------------------
Fax | 412-673-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 723 BRADDOCK AVE
-----------------------------------------------------
City | BRADDOCK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15104-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-351-0222
-----------------------------------------------------
Fax | 412-351-2616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | FRAN SHEEDY BOST
-----------------------------------------------------
Credential | MED
-----------------------------------------------------
Telephone | 412-351-0222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 422510
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------