Healthcare Provider Details

I. General information

NPI: 1386626919
Provider Name (Legal Business Name): PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HANOVER AVE
ALLENTOWN PA
18109-2408
US

IV. Provider business mailing address

1600 HANOVER AVE
ALLENTOWN PA
18109-2408
US

V. Phone/Fax

Practice location:
  • Phone: 610-740-3401
  • Fax: 610-740-3275
Mailing address:
  • Phone: 610-740-3401
  • Fax: 610-740-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES K. ROSENBERRY
Title or Position: CEO
Credential:
Phone: 610-740-3401