Healthcare Provider Details

I. General information

NPI: 1386498921
Provider Name (Legal Business Name): CHANNEL BEHAVIORAL CARE PA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W MAIN ST
MOUNT JOY PA
17552-9666
US

IV. Provider business mailing address

50 W EDMONSTON DR STE 402
ROCKVILLE MD
20852-1245
US

V. Phone/Fax

Practice location:
  • Phone: 646-238-4930
  • Fax:
Mailing address:
  • Phone: 646-238-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SIMCHA SILBERMAN
Title or Position: DIRECTOR
Credential: RBT
Phone: 646-238-4930