| Mistyisle Bridge. Inc | |
|
9664 Route 322 Shippenville PA 16254-8734 | |
| (814) 226-1153 | |
| (814) 226-1156 |
| Full Name | Mistyisle Bridge. Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9664 Route 322, Shippenville, Pennsylvania |
| Authorized Official Name and Position | Terrance Bean (PRESIDENT) |
| Authorized Official Contact | 8142261153 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mistyisle Bridge. Inc Po Box 605 Clarion PA 16214-0605 Ph: (814) 226-1153 | Mistyisle Bridge. Inc 9664 Route 322 Shippenville PA 16254-8734 Ph: (814) 226-1153 |
| NPI Number | 1487784146 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 10/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487784146 | NPI | - | NPPES |
| 1012740580001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 424960 (Pennsylvania) | Primary |
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