Organization
FAYETTE COUNTY MENTAL HEALTH MENTAL RETARDATION PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RIDER M.A., M.DIV. (ADMINISTRATOR CEO)
(724) 430-1370
Entity
Organization
Contact information
Practice address
215 JACOB MURPHY LN, UNIONTOWN, PA 15401-2777
(724) 430-1370
(724) 430-1386
Mailing address
215 JACOB MURPHY LN, UNIONTOWN, PA 15401-2777
(724) 430-1370
(724) 430-1386
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251B00000X
Case Management Agency
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017040300001
—
PA
05
—
1007538290003
—
PA
05
—
1007538290004
—
PA
05
—
1007538290005
—
PA
Enumeration date
03/13/2007
Last updated
01/03/2024
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