Provider Demographics
NPI:1073785697
Name:PERSEUS HOUSE INC
Entity Type:Organization
Organization Name:PERSEUS HOUSE INC
Other - Org Name:BRIGHTER HORIZONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-480-5956
Mailing Address - Street 1:1511 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2104
Mailing Address - Country:US
Mailing Address - Phone:814-480-5911
Mailing Address - Fax:814-454-8670
Practice Address - Street 1:6101 WEST RD
Practice Address - Street 2:
Practice Address - City:MC KEAN
Practice Address - State:PA
Practice Address - Zip Code:16426-1123
Practice Address - Country:US
Practice Address - Phone:814-476-7514
Practice Address - Fax:814-476-7417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSEUS HOUSE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA435250323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007713900038Medicaid