Provider Demographics
NPI:1598920654
Name:MACEDONIA FAMILY AND COMMUNITY ENRICHMENT CENTER, INC
Entity type:Organization
Organization Name:MACEDONIA FAMILY AND COMMUNITY ENRICHMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,BCD
Authorized Official - Phone:412-281-2573
Mailing Address - Street 1:2226 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-4056
Mailing Address - Country:US
Mailing Address - Phone:412-281-2573
Mailing Address - Fax:412-281-3854
Practice Address - Street 1:2851 BEDFORD AVE STE 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4067
Practice Address - Country:US
Practice Address - Phone:412-687-8004
Practice Address - Fax:412-687-6950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019767755Medicaid
PA001626174OtherHIGHMARK