Provider Demographics
NPI:1316349186
Name:PASSAVANT MEMORIAL HOMES
Entity type:Organization
Organization Name:PASSAVANT MEMORIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-820-1010
Mailing Address - Street 1:163 THORN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-7527
Mailing Address - Country:US
Mailing Address - Phone:412-820-1010
Mailing Address - Fax:
Practice Address - Street 1:215 JACKSON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-1413
Practice Address - Country:US
Practice Address - Phone:412-820-1010
Practice Address - Fax:412-820-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA446270251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health