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General NPI Number Information
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NPI Number | 1275757692
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Entity Type | Organization
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Legal Business Name | EDGEWATER PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 295 STATE DR
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City | ELIZABETHVILLE
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State | PA
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Zip | 17023-8661
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Country | US
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Telephone | 215-836-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 4391 STURBRIDGE DR
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City | HARRISBURG
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State | PA
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Zip | 17110-3673
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Country | US
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Telephone | 215-836-3131
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS OPERATIONS
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Name | MR. NORMAN TILSON JR.
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Credential |
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Telephone | 215-836-3131
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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 |
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License Number State |
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