Healthcare Provider Details

I. General information

NPI: 1801163936
Provider Name (Legal Business Name): PENN FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FAIRVIEW AVE
QUAKERTOWN PA
18951-2850
US

IV. Provider business mailing address

PO BOX 32
SELLERSVILLE PA
18960-0032
US

V. Phone/Fax

Practice location:
  • Phone: 215-257-6551
  • Fax: 215-257-9347
Mailing address:
  • Phone: 215-257-6551
  • Fax: 215-257-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WAYNE MUGRAUER
Title or Position: PRESIDENT/CEO
Credential: M.P.A.
Phone: 215-257-6551