MEDICARE: PHILHAVEN

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency
2	283Q00000X	Psychiatric Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	318550	OTHER	PA	CERTIFICATE OF COMPLIANCE LICENSE NUMBER

NPI Number	:	1972598076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILHAVEN

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	283 S BUTLER RD
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-8939
Country	:	US
Telephone Number	:	800-932-0359
Fax Number	:

Authorized Official
Title or Position	:	VP & PRESIDENT PHILHAVEN
Name	:	MANTHA KOTSALOS
Credential	:
Telephone Number	:	717-270-2423

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	06/12/2026

239 S BUTLER RD
LEBANON, PA
17042-8939

Practice Phone: 717-270-2422
Practice Fax: