Healthcare Provider Details

I. General information

NPI: 1962531152
Provider Name (Legal Business Name): PEDIA MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 DURHAM RD
PIPERSVILLE PA
18947-1215
US

IV. Provider business mailing address

2881 GOLF CIR
EMMAUS PA
18049-1733
US

V. Phone/Fax

Practice location:
  • Phone: 215-766-2183
  • Fax: 215-766-2184
Mailing address:
  • Phone: 610-984-4258
  • Fax: 866-709-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number124070
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number124950
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number121200
License Number StatePA

VIII. Authorized Official

Name: MR. SUDESH SINGH
Title or Position: PRESIDENT
Credential:
Phone: 215-262-6340