Healthcare Provider Details

I. General information

NPI: 1255667242
Provider Name (Legal Business Name): EIHAB HUMAN SERVICES PENNSYLVANIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 6 BOX 6543
MOSCOW PA
18444-9665
US

IV. Provider business mailing address

16818 S CONDUIT AVE
JAMAICA NY
11434-4899
US

V. Phone/Fax

Practice location:
  • Phone: 570-309-6579
  • Fax: 570-309-6362
Mailing address:
  • Phone: 718-276-6101
  • Fax: 718-276-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANE MEROLLA
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential:
Phone: 570-309-6579