Basic Information
| Provider Information | |||||||||
| NPI: | 1780809806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHILHAVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 S BUTLER ROAD | ||||||||
| Address2: | |||||||||
| City: | MT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17064 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 283 S BUTLER ROAD | ||||||||
| Address2: | |||||||||
| City: | MT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009320359 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | YUTZY | ||||||||
| AuthorizedOfficialFirstName: | LAVERN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8009320359 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1007720000088 | 05 | PA | MEDICAID |