Healthcare Provider Details

I. General information

NPI: 1942271440
Provider Name (Legal Business Name): PERSEUS HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 E 6TH ST
ERIE PA
16507-1729
US

IV. Provider business mailing address

1511 PEACH ST
ERIE PA
16501-2104
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-4271
  • Fax:
Mailing address:
  • Phone: 814-480-5911
  • Fax: 814-454-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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