Basic Information
| Provider Information | |||||||||
| NPI: | 1962652206 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STAIRWAYS BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144648311 | ||||||||
| FaxNumber: | 8144648462 | ||||||||
| Practice Location | |||||||||
| Address1: | 2185 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165054747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144648311 | ||||||||
| FaxNumber: | 8144648462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 01/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | ERNST | ||||||||
| AuthorizedOfficialFirstName: | ANN MARIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR OF BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8144648311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1000063480045 | 05 | PA | MEDICAID |