Healthcare Provider Details

I. General information

NPI: 1174686026
Provider Name (Legal Business Name): COLONIAL HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WOODBERRY ROAD
YORK PA
17408-5840
US

IV. Provider business mailing address

1300 WOODBERRY ROAD
YORK PA
17408-5840
US

V. Phone/Fax

Practice location:
  • Phone: 717-792-1366
  • Fax: 717-792-9910
Mailing address:
  • Phone: 717-792-1366
  • Fax: 717-792-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number677065
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number671099
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ADRIANE BASARAB
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, CADC, CCS
Phone: 717-792-1366