Provider Demographics
NPI:1073572715
Name:PENN FOUNDATION INC
Entity Type:Organization
Organization Name:PENN FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUGRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:215-453-5160
Mailing Address - Street 1:807 LAWN AVENUE
Mailing Address - Street 2:PO BOX 32
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:215-257-9347
Practice Address - Street 1:807 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1549
Practice Address - Country:US
Practice Address - Phone:215-257-6551
Practice Address - Fax:215-257-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE113171Medicaid
PA129323OtherHEALTH CHOICES
PAPE113171Medicare ID - Type Unspecified