Organization
CENTERVILLE CLINICS, INC CONNELLSVILLE MH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTY MARTOS (DIRECTOR FINANCE AND PERSONNEL)
(724) 632-6801
Entity
Organization
Contact information
Practice address
208 S ARCH ST, CONNELLSVILLE, PA 15425-3519
(724) 626-2630
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
391911
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440037
—
PA
01
—
328834A776089
VALUE BEHAVIORAL HEALTH
PA
01
—
391911
NATIONAL GOVERNMENT SERVICES
PA
Enumeration date
05/01/2008
Last updated
05/01/2008
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