Provider Demographics
NPI:1861422834
Name:CLARION CO MH MR DRUG & ALCOHOL
Entity type:Organization
Organization Name:CLARION CO MH MR DRUG & ALCOHOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MH MR DRUG & ALCOHOL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-226-6252
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:814-226-6252
Mailing Address - Fax:814-226-8564
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:814-226-6252
Practice Address - Fax:814-226-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Not Answered251B00000XAgenciesCase Management
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000073900014Medicaid
PA1000073900017Medicaid
PA660501OtherHIGHMARK BC/BS
PA4634563OtherAETNA INSURANCE
PA1000073900008Medicaid
PA1000073900009Medicaid
PA1000073900016Medicaid
PA1000073900019Medicaid
PA1000073900020Medicaid
PA100007390025Medicaid
PA1000073900005Medicaid
PA1000073900006Medicaid
PA1000073900008Medicaid