Healthcare Provider Details

I. General information

NPI: 1790768471
Provider Name (Legal Business Name): PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN DR
NORTH WARREN PA
16365-5001
US

IV. Provider business mailing address

33 MAIN DR
NORTH WARREN PA
16365-5001
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-4258
  • Fax: 814-726-4378
Mailing address:
  • Phone: 814-726-4258
  • Fax: 814-726-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHY LIGHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 717-772-2517