Healthcare Provider Details

I. General information

NPI: 1164751178
Provider Name (Legal Business Name): MERAKEY PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BRIDGE ST APT 3
TOWANDA PA
18848-1640
US

IV. Provider business mailing address

4251 CRUMS MILL RD
HARRISBURG PA
17112-2824
US

V. Phone/Fax

Practice location:
  • Phone: 717-441-9565
  • Fax:
Mailing address:
  • Phone: 215-836-3131
  • Fax: 215-273-5975

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: MR. NORMAN E TILSON JR.
Title or Position: CORP SR. DIRECTOR OF BUSINESS OPS
Credential:
Phone: 215-836-3131