Healthcare Provider Details

I. General information

NPI: 1831618065
Provider Name (Legal Business Name): PENNSYLVANIA HEALTH OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PHOENIXVILLE PIKE
MALVERN PA
19355-1046
US

IV. Provider business mailing address

L-4381
COLUMBUS OH
43260-4381
US

V. Phone/Fax

Practice location:
  • Phone: 610-228-0670
  • Fax: 866-273-8095
Mailing address:
  • Phone: 714-202-5166
  • Fax: 866-273-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number143180
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number157070
License Number StatePA

VIII. Authorized Official

Name: KEVIN THOMPSON
Title or Position: CHIEF LEGAL AND DEVELOPMENT OFFICER
Credential:
Phone: 949-432-4622