Provider Demographics
NPI:1255667242
Name:EIHAB HUMAN SERVICES PENNSYLVANIA INC
Entity Type:Organization
Organization Name:EIHAB HUMAN SERVICES PENNSYLVANIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEROLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-309-6579
Mailing Address - Street 1:16818 S CONDUIT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4899
Mailing Address - Country:US
Mailing Address - Phone:718-276-6101
Mailing Address - Fax:718-276-6063
Practice Address - Street 1:RR 6 BOX 6543
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9665
Practice Address - Country:US
Practice Address - Phone:570-309-6579
Practice Address - Fax:570-309-6362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EIHAB HUMAN SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 320600000X, 322D00000X
PA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities