MEDICARE: GREATER READING MENTAL HEALTH ALLIANCE

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	261Q00000X	Clinic/Center	261Q00000X	PA
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	261QM0801X	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	:	1750677696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER READING MENTAL HEALTH ALLIANCE

Provider Business Mailing Address
First Line	:	1234 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2130
Country	:	US
Telephone Number	:	610-775-3000
Fax Number	:	610-775-4000

Provider Business Practice Location Address
First Line	:	1234 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-2130
Country	:	US
Telephone Number	:	610-775-3000
Fax Number	:	610-775-4000

Authorized Official
Title or Position	:	PEER SUPPORT DIRECTOR
Name	:	MR. JOSEPH KOZAK
Credential	:
Telephone Number	:	610-775-3000

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	09/25/2012

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Directions to “GREATER READING MENTAL HEALTH ALLIANCE ” Practice Location

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