Provider Demographics
NPI:1154304483
Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Other - Org Name:EBENSBURG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-772-2518
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-0600
Mailing Address - Country:US
Mailing Address - Phone:814-472-7350
Mailing Address - Fax:814-472-0542
Practice Address - Street 1:4051 ADMIRAL PEARY HWY
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4332
Practice Address - Country:US
Practice Address - Phone:814-472-0200
Practice Address - Fax:814-472-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PA481146Medicare PIN
PACN9313Medicare PIN
PACK4681Medicare PIN