Basic Information
| Provider Information | |||||||||
| NPI: | 1932621364 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPMC SUSQUEHANNA SUNBURY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUNBURY COMMUNITY HOSPITAL BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRANT STREET, US STEEL TOWER, 59TH FLOOR | ||||||||
| Address2: | C/O RENEE JOHNSON | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152192740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126236303 | ||||||||
| FaxNumber: | 4126236369 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 N 11TH ST | ||||||||
| Address2: | |||||||||
| City: | SUNBURY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178011611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702863333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | STOCKHAUSEN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4125789592 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.