Healthcare Provider Details

I. General information

NPI: 1730565557
Provider Name (Legal Business Name): HOLY SPIRIT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 POPLAR CHURCH RD
CAMP HILL PA
17011-2250
US

IV. Provider business mailing address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-2274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007718810081
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MANUEL EVANS
Title or Position: CFO, SENIOR VP FINANCE
Credential:
Phone: 717-763-2130