MEDICARE: BEAVER COUNTY MH MR D&A PROGRAM

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	251B00000X	Case Management 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

General Provider Information

NPI Number	:	1871716274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVER COUNTY MH MR D&A PROGRAM

Provider Business Mailing Address
First Line	:	1040 8TH AVE
Second Line	:	HUMAN SERVICES BUILDING, FLOOR 2
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-4506
Country	:	US
Telephone Number	:	724-847-6225
Fax Number	:	724-891-2865

Provider Business Practice Location Address
First Line	:	1040 8TH AVE
Second Line	:	HUMAN SERVICES BUILDING, FLOOR 2
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-4506
Country	:	US
Telephone Number	:	724-847-6225
Fax Number	:	724-891-2865

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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