MEDICARE: THREE RIVERS ADOPTION COUNCIL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
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

General Provider Information

NPI Number	:	1689853103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS ADOPTION COUNCIL

Provider Business Mailing Address
First Line	:	1600 W CARSON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-1031
Country	:	US
Telephone Number	:	412-471-8722
Fax Number	:	412-471-4861

Provider Business Practice Location Address
First Line	:	1600 W CARSON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-1031
Country	:	US
Telephone Number	:	412-471-8722
Fax Number	:	412-471-4861

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JACQUELINE D WILSON
Credential	:	LSW
Telephone Number	:	412-471-8722

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	07/03/2020

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