Healthcare Provider Details

I. General information

NPI: 1497739973
Provider Name (Legal Business Name): PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST
WERNERSVILLE PA
19565-9490
US

IV. Provider business mailing address

160 MAIN ST
WERNERSVILLE PA
19565-9490
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-4111
  • Fax: 610-670-4111
Mailing address:
  • Phone: 610-670-4111
  • Fax: 610-670-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: KATHY LIGHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 717-772-2517