Provider Demographics
NPI:1902889876
Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Other - Org Name:MAYVIEW STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-257-6226
Mailing Address - Street 1:1601 MAYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1547
Mailing Address - Country:US
Mailing Address - Phone:412-257-6226
Mailing Address - Fax:412-257-6808
Practice Address - Street 1:1601 MAYVIEW RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1547
Practice Address - Country:US
Practice Address - Phone:412-257-6226
Practice Address - Fax:412-257-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PA394018Medicare Oscar/Certification
PA100308518Medicaid
PAC30800Medicare PIN