Healthcare Provider Details

I. General information

NPI: 1114980489
Provider Name (Legal Business Name): PENNSYLVANIA COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CAPE HORN RD
RED LION PA
17356-9057
US

IV. Provider business mailing address

2555 CAPE HORN RD
RED LION PA
17356-9057
US

V. Phone/Fax

Practice location:
  • Phone: 717-600-0900
  • Fax: 717-600-0910
Mailing address:
  • Phone: 717-600-0900
  • Fax: 717-600-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number316610
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number329640
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number316610
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number329640
License Number StatePA

VIII. Authorized Official

Name: HEATHER MALETZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-600-0900