Provider Demographics
NPI:1114980489
Name:PENNSYLVANIA COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PENNSYLVANIA COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MALETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-600-0900
Mailing Address - Street 1:2555 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9057
Mailing Address - Country:US
Mailing Address - Phone:717-600-0900
Mailing Address - Fax:717-600-0910
Practice Address - Street 1:2555 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9057
Practice Address - Country:US
Practice Address - Phone:717-600-0900
Practice Address - Fax:717-600-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA316610261QM0850X, 261QM0855X
PA329640261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1579417OtherHIGHMARK BS
PA50035025OtherCAPITAL BLUE CROSS
PA1579416OtherHIGHMARK BS
PA1007511540006Medicaid
PA50035025OtherCAPITAL BLUE CROSS
PA1579416OtherHIGHMARK BS
PA1579417OtherHIGHMARK BS
141601Medicare PIN
751131Medicare PIN