Healthcare Provider Details

I. General information

NPI: 1366508871
Provider Name (Legal Business Name): POTTER COUNTY HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 NORTH ST.
ROULETTE PA
16746-0241
US

IV. Provider business mailing address

PO BOX 241
ROULETTE PA
16746-0241
US

V. Phone/Fax

Practice location:
  • Phone: 814-544-7315
  • Fax: 814-544-9062
Mailing address:
  • Phone: 814-544-7315
  • Fax: 814-544-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number100733450
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1007334500006
License Number StatePA

VIII. Authorized Official

Name: MR. DOUGLAS C MORLEY
Title or Position: COUNTY COMMISSIONERS CHAIRMAN
Credential:
Phone: 814-274-8290