Provider Demographics
NPI:1275758393
Name:PHILHAVEN
Entity Type:Organization
Organization Name:PHILHAVEN
Other - Org Name:WELLSPAN PHILHAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP BEHAVIORAL HEALTH NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-273-8871
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:283 S BUTLER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8939
Practice Address - Country:US
Practice Address - Phone:800-932-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007720000133Medicaid
PA1007720000137Medicaid
PA1007720000076Medicaid
PA1007720000131Medicaid
PA1007720000138Medicaid
PA1007720000135Medicaid
PA1007720000152Medicaid
PA1007720000127Medicaid
PA1007720000128Medicaid
PA1007720000132Medicaid
PA1007720000134Medicaid
PA1007720000136Medicaid
PA1007720000138Medicaid
PA1007720000137Medicaid