=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790063352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEDWIG HOUSE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2011
-----------------------------------------------------
Last Update Date | 08/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2506 N BROAD ST SUITE 200
-----------------------------------------------------
City | COLMAR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18915-9439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-477-1070
-----------------------------------------------------
Fax | 267-477-1071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2506 N BROAD ST SUITE 200
-----------------------------------------------------
City | COLMAR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18915-9439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-477-1070
-----------------------------------------------------
Fax | 267-477-1071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. KAREN BITTING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-279-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------