Organization
MISTYISLE BRIDGE. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRANCE BEAN (PRESIDENT)
(814) 226-1153
Entity
Organization
Contact information
Practice address
9664 ROUTE 322, SHIPPENVILLE, PA 16254-8734
(814) 226-1153
(814) 226-1156
Mailing address
PO BOX 605, CLARION, PA 16214-0605
(814) 226-1153
(814) 226-1156
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
424960
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012740580001
—
PA
Enumeration date
03/06/2007
Last updated
10/15/2009
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