Healthcare Provider Details

I. General information

NPI: 1396880621
Provider Name (Legal Business Name): CHILDREN'S HOME OF YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SHOE HOUSE RD
HELLAM PA
17406
US

IV. Provider business mailing address

77 SHOE HOUSE RD
HELLAM PA
17406-8025
US

V. Phone/Fax

Practice location:
  • Phone: 717-755-1033
  • Fax: 717-755-9993
Mailing address:
  • Phone: 717-755-1033
  • Fax: 717-755-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number320980
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number320980
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number327620
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number303660
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number320980
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number316860
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number677058
License Number StatePA

VIII. Authorized Official

Name: JOHANNA ELMER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 717-755-1033