Provider Demographics
NPI:1992925689
Name:CLARION COUNTY MENTAL RETARDATION
Entity type:Organization
Organization Name:CLARION COUNTY MENTAL RETARDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:RHODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-226-1080
Mailing Address - Street 1:214 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-2053
Mailing Address - Country:US
Mailing Address - Phone:814-226-1080
Mailing Address - Fax:814-226-1157
Practice Address - Street 1:214 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-2053
Practice Address - Country:US
Practice Address - Phone:814-226-1080
Practice Address - Fax:814-226-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management