Provider Demographics
NPI:1154354553
Name:STO-ROX NEIGHBORHOOD HEALTH COUNCIL, INC.
Entity type:Organization
Organization Name:STO-ROX NEIGHBORHOOD HEALTH COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-771-6462
Mailing Address - Street 1:710 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-3808
Mailing Address - Country:US
Mailing Address - Phone:412-771-6462
Mailing Address - Fax:412-771-5887
Practice Address - Street 1:710 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-3808
Practice Address - Country:US
Practice Address - Phone:412-771-6462
Practice Address - Fax:412-771-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007778110002Medicaid
PA1007778110002Medicaid
PA17379D5WMedicare PIN