Provider Demographics
NPI:1104960277
Name:TURTLE CREEK VALLEY MH MR INC
Entity type:Organization
Organization Name:TURTLE CREEK VALLEY MH MR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEDY BOST
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:412-351-0222
Mailing Address - Street 1:723 BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1849
Mailing Address - Country:US
Mailing Address - Phone:412-351-0222
Mailing Address - Fax:412-351-2616
Practice Address - Street 1:1705 MAPLE ST
Practice Address - Street 2:ALSO USES 201 E 18TH AVE
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1800
Practice Address - Country:US
Practice Address - Phone:412-461-4100
Practice Address - Fax:412-461-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422510261QM0850X, 261QM0855X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
340652OtherTRICARE CHAMPUS
648025OtherHIGHMARK
1760666OtherHIGHMARK
IG001416OtherMAGELLAN
1040548OtherGATEWAY HEALTH PLAN MEDICARE ASSURED
PA1007281380052Medicaid
111270OtherVALUE OPTIONS
PA1007281380009Medicaid
PA1007281380023Medicaid
1760672OtherHIGHMARK
1040548OtherGATEWAY HEALTH PLAN MEDICARE ASSURED
111270OtherVALUE OPTIONS