Provider Demographics
NPI:1104245661
Name:COMMUNITY GUIDANCE CENTER
Entity type:Organization
Organization Name:COMMUNITY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-465-5576
Mailing Address - Street 1:793 OLD ROUTE 119 HIGHWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-465-5576
Mailing Address - Fax:724-465-6379
Practice Address - Street 1:200 PRUSHNOK DRIVE - LEVER STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767
Practice Address - Country:US
Practice Address - Phone:814-938-4444
Practice Address - Fax:814-938-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management