MEDICARE: POTTER COUNTY HUMAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	1007334500006	PA
2	251B00000X	Case Management Agency	100733450	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366508871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTTER COUNTY HUMAN SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 241
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-0241
Country	:	US
Telephone Number	:	814-544-7315
Fax Number	:	814-544-9062

Provider Business Practice Location Address
First Line	:	62 NORTH ST.
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-0241
Country	:	US
Telephone Number	:	814-544-7315
Fax Number	:	814-544-9062

Authorized Official
Title or Position	:	COUNTY COMMISSIONERS CHAIRMAN
Name	:	MR. DOUGLAS C MORLEY
Credential	:
Telephone Number	:	814-274-8290

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/16/2016

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