Basic Information
| Provider Information | |||||||||
| NPI: | 1780704692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STAIRWAYS BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 E 26TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165041049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144535806 | ||||||||
| FaxNumber: | 8144534757 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 STATE ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165081832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144545686 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | KIRKWOOD | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8144535806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 257073 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 261Q00000X | 257073 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 1000063480017 | 05 | PA | MEDICAID |