Healthcare Provider Details

I. General information

NPI: 1710019096
Provider Name (Legal Business Name): PENNDEL MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 DURHAM RD
PENNDEL PA
19047-5707
US

IV. Provider business mailing address

1723 WOODBOURNE RD SUITE A110
LEVITTOWN PA
19057-1510
US

V. Phone/Fax

Practice location:
  • Phone: 215-752-1541
  • Fax: 215-752-2848
Mailing address:
  • Phone: 267-587-2300
  • Fax: 267-587-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number123890
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN M GRAFF
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 267-587-2300