MEDICARE: BEAVER COUNTY MH MR DRUG & ALCOHOL PROGRAM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251K00000X	Public Health or Welfare Agency
3	251S00000X	Community/Behavioral Health Agency

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457408759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVER COUNTY MH MR DRUG & ALCOHOL PROGRAM

Provider Business Mailing Address
First Line	:	1040 8TH AVE
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-4506
Country	:	US
Telephone Number	:	724-847-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 8TH AVE
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-4506
Country	:	US
Telephone Number	:	724-847-6225
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GERARD MIKE
Credential	:
Telephone Number	:	724-847-6225

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/06/2009

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