Organization
CLEARFIELD-JEFFERSON MHMR PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLETTE DUSHAC (ADMINISTRATOR)
(814) 265-1060
Entity
Organization
Contact information
Practice address
1200 WOOD ST STE U110, BROCKWAY, PA 15824-2118
(814) 265-1060
(814) 265-1049
Mailing address
1200 WOOD ST STE U110, BROCKWAY, PA 15824-2118
(814) 265-1060
(814) 265-1049
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007332450001
—
PA
Enumeration date
12/22/2006
Last updated
08/22/2020
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