Provider Demographics
NPI:1396994885
Name:CONNEAUT VALLEY HEALTH CENTER INC.
Entity type:Organization
Organization Name:CONNEAUT VALLEY HEALTH CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:814-373-2449
Mailing Address - Street 1:906 WASHINGTON ST
Mailing Address - Street 2:PO BOX E
Mailing Address - City:CONNEAUTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16406-7138
Mailing Address - Country:US
Mailing Address - Phone:814-373-2276
Mailing Address - Fax:814-587-2918
Practice Address - Street 1:747 TERRACE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-1737
Practice Address - Country:US
Practice Address - Phone:814-373-2976
Practice Address - Fax:814-333-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007230030015Medicaid
PACE7746OtherRR MEDICARE
PA191386OtherHIGHMARK BC/BS
PA393911Medicare Oscar/Certification