Organization
CENTERVILLE CLINICS, INC PEER SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTY MARTOS (DIRECTOR FINANCE/PERSONNEL)
(724) 632-6801
Entity
Organization
Contact information
Practice address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
422450
CERTIFICATE OF COMPLIANCE
PA
Enumeration date
10/24/2007
Last updated
10/24/2007
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