Provider Demographics
NPI:1013034750
Name:ADELPHOI VILLAGE, INC.
Entity Type:Organization
Organization Name:ADELPHOI VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-804-7193
Mailing Address - Street 1:1119 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5201
Mailing Address - Country:US
Mailing Address - Phone:724-520-1111
Mailing Address - Fax:724-520-1878
Practice Address - Street 1:1119 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5201
Practice Address - Country:US
Practice Address - Phone:724-520-1111
Practice Address - Fax:724-520-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA423910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007447300020Medicaid