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General NPI Number Information
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NPI Number | 1255480174
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Entity Type | Organization
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Legal Business Name | PERSEUS HOUSE, INC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 1510 STATE ST
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City | ERIE
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State | PA
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Zip | 16501-2220
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Country | US
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Telephone | 814-480-5905
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Fax | 814-456-4229
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Provider Business Mailing Address
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Address Line | 1511 PEACH ST
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City | ERIE
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State | PA
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Zip | 16501-2104
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Country | US
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Telephone | 814-480-5911
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Fax | 814-454-8670
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARK AMENDOLA
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Credential |
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Telephone | 814-480-5956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 407390
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License Number State | PA
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