Healthcare Provider Details

I. General information

NPI: 1073785697
Provider Name (Legal Business Name): PERSEUS HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 WEST RD
MC KEAN PA
16426-1123
US

IV. Provider business mailing address

1511 PEACH ST
ERIE PA
16501-2104
US

V. Phone/Fax

Practice location:
  • Phone: 814-476-7514
  • Fax: 814-476-7417
Mailing address:
  • Phone: 814-480-5911
  • Fax: 814-454-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number435250
License Number StatePA

VIII. Authorized Official

Name: MR. MARK A AMENDOLA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 814-480-5956