Healthcare Provider Details

I. General information

NPI: 1184698326
Provider Name (Legal Business Name): PERSEUS HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 STATE ST
ERIE PA
16501-2220
US

IV. Provider business mailing address

1511 PEACH ST
ERIE PA
16501
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-5900
  • Fax: 814-454-8670
Mailing address:
  • Phone: 814-480-5900
  • Fax: 814-454-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CORINA SUTTON
Title or Position: ACCOUNTING SPECIALIST
Credential:
Phone: 814-480-5911