Healthcare Provider Details

I. General information

NPI: 1376923896
Provider Name (Legal Business Name): NORTH PENN COMPREHENSIVE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W WELLSBORO ST
MANSFIELD PA
16933-1411
US

IV. Provider business mailing address

40 W WELLSBORO ST
MANSFIELD PA
16933-1411
US

V. Phone/Fax

Practice location:
  • Phone: 570-723-0620
  • Fax:
Mailing address:
  • Phone: 570-662-1945
  • Fax: 570-662-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA M. VANZILE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 570-662-1945