=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174427504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN STATES HEALTH CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 N LEWIS RD
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-447-7272
-----------------------------------------------------
Fax | 484-762-6596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 N LEWIS RD
-----------------------------------------------------
City | ROYERSFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19468-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-447-7272
-----------------------------------------------------
Fax | 484-762-6596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ELEEN JUMA
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 484-767-8047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------