Provider Demographics
NPI:1699986125
Name:FAMILY SERVICE AND CHILDREN'S AID SOCIETY OF VENANGO COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE AND CHILDREN'S AID SOCIETY OF VENANGO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL TECH III
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-677-4005
Mailing Address - Street 1:716 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2330
Mailing Address - Country:US
Mailing Address - Phone:814-677-4005
Mailing Address - Fax:814-677-6159
Practice Address - Street 1:716 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2330
Practice Address - Country:US
Practice Address - Phone:814-677-4005
Practice Address - Fax:814-677-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA617010251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000016370012Medicaid