Basic Information
| Provider Information | |||||||||
| NPI: | 1134617376 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLADE RUN MEDICAL ASSOCIATES, INC. | ||||||||
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| OtherOrganizationName: | ARMSTRONG BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MEDICAL ARTS BLDG STE 710 | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438626 | ||||||||
| FaxNumber: | 7245438736 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 NOLTE DR | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2018 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE / CFO | ||||||||
| AuthorizedOfficialTelephone: | 7245438618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.