MEDICARE: JUNIATA COMMUNITY MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	111780	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134267214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNIATA COMMUNITY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	2637-45 N. 5TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-0000
Country	:	US
Telephone Number	:	215-291-0550
Fax Number	:	215-291-0566

Provider Business Practice Location Address
First Line	:	2637-45 N. 5TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-0000
Country	:	US
Telephone Number	:	215-291-0550
Fax Number	:	215-291-0566

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. ROLAND TURK
Credential	:	MSW
Telephone Number	:	215-291-0550

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/24/2013

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Directions to “JUNIATA COMMUNITY MENTAL HEALTH ” Practice Location

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