Provider Demographics
NPI:1023021219
Name:NORTHWESTERN HUMAN SERVICES OF SUSQUEHANNA VALLEY INC
Entity Type:Organization
Organization Name:NORTHWESTERN HUMAN SERVICES OF SUSQUEHANNA VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NHS PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:610-260-4618
Mailing Address - Street 1:620 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1810
Mailing Address - Country:US
Mailing Address - Phone:610-260-4600
Mailing Address - Fax:610-260-4699
Practice Address - Street 1:620 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1810
Practice Address - Country:US
Practice Address - Phone:610-260-4600
Practice Address - Fax:610-260-4699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NHS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health