Healthcare Provider Details

I. General information

NPI: 1841317575
Provider Name (Legal Business Name): ADELPHOI VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 VILLAGE WAY
LATROBE PA
15650-5201
US

IV. Provider business mailing address

1119 VILLAGE WAY
LATROBE PA
15650-5201
US

V. Phone/Fax

Practice location:
  • Phone: 724-520-1111
  • Fax: 724-520-1878
Mailing address:
  • Phone: 724-520-1111
  • Fax: 724-520-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number423910
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number423910
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number423910
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number423910
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DANA MALDET
Title or Position: DIRECTOR OF REVENUE CYCLE MANAGEMEN
Credential:
Phone: 724-804-7159