Healthcare Provider Details

I. General information

NPI: 1154541837
Provider Name (Legal Business Name): THE CLINIC FOR SPECIAL CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/22/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMUNITY LANE
GORDONVILLE PA
17529
US

IV. Provider business mailing address

PO BOX 500
INTERCOURSE PA
17534-9998
US

V. Phone/Fax

Practice location:
  • Phone: 717-687-9407
  • Fax: 717-687-9237
Mailing address:
  • Phone: 717-687-9407
  • Fax: 717-687-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number39D0662473
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number021547
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM D HEAPS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 717-687-9407