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General NPI Number Information
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NPI Number | 1740310176
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Entity Type | Organization
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Legal Business Name | DEERFIELD BEHAVIORAL HEALTH OF WARREN
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 115 W SPRING ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-1763
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Country | US
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Telephone | 814-827-3467
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Fax | 814-827-8212
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Provider Business Mailing Address
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Address Line | 1003 PENNSYLVANIA AVE W FL 2
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City | WARREN
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State | PA
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Zip | 16365-1876
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Country | US
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Telephone | 814-723-5545
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Fax | 814-362-5245
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Authorized Official
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Title or Position | EX DIR
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Name | TINA CARY
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Credential |
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Telephone | 814-723-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 207012
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License Number State | PA
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