Provider Demographics
NPI:1336210699
Name:VIAQUEST BEHAVIAORL HEALTH OF PA, LLC
Entity type:Organization
Organization Name:VIAQUEST BEHAVIAORL HEALTH OF PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-645-3267
Mailing Address - Street 1:525 METRO PL N
Mailing Address - Street 2:SUITE 450
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5342
Mailing Address - Country:US
Mailing Address - Phone:800-645-3267
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2082
Practice Address - Country:US
Practice Address - Phone:717-242-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA316910261QM0855X
PA301480320800000X
PA302410320800000X
PA316970322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019621050003Medicaid
PA0019621050001Medicaid
PA0019621050004Medicaid
PA0019621050002Medicaid
PA0428OtherBLUE CROSS PROVIDER #
PA5011962105OtherCBHNP PROVIDER #