Healthcare Provider Details

I. General information

NPI: 1710578455
Provider Name (Legal Business Name): PAHM-NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 OREGON PIKE
LANCASTER PA
17601-4604
US

IV. Provider business mailing address

2141 OREGON PIKE
LANCASTER PA
17601-4604
US

V. Phone/Fax

Practice location:
  • Phone: 717-617-2706
  • Fax:
Mailing address:
  • Phone: 717-617-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE E GILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 717-808-6179