Healthcare Provider Details

I. General information

NPI: 1952481616
Provider Name (Legal Business Name): PENN PSYCHIATRIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GAY ST SUITE6
PHOENIXVILLE PA
19460-3852
US

IV. Provider business mailing address

PO BOX 187
GWYNEDD VALLEY PA
19437-0187
US

V. Phone/Fax

Practice location:
  • Phone: 610-917-2200
  • Fax: 610-917-2360
Mailing address:
  • Phone: 610-917-2200
  • Fax: 610-917-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number117910
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number117910
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number117910
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number117910
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number039341L
License Number StatePA

VIII. Authorized Official

Name: DR. SAMIR FARAG
Title or Position: PRESIDENT PSYCHIATRIST
Credential: MD
Phone: 610-917-2200