MEDICARE: MORIAH BEHAVIORAL HEALTH CO.

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1134849144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORIAH BEHAVIORAL HEALTH CO.

Provider Business Mailing Address
First Line	:	512 NORTHAMPTON ST # 158
Second Line	:
City	:	EDWARDSVILLE
State	:	PA
Zip	:	18704-4560
Country	:	US
Telephone Number	:	570-203-9222
Fax Number	:	570-203-9477

Provider Business Practice Location Address
First Line	:	2330 PASEO DEL PRADO # C101L
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4359
Country	:	US
Telephone Number	:	725-272-0330
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, BILLING & COLLECTIONS
Name	:	MELISSA MARSHALL
Credential	:
Telephone Number	:	570-203-9222

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	03/27/2024

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