Provider Demographics
NPI:1346561842
Name:PENNDEL MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:PENNDEL MENTAL HEALTH CENTER
Other - Org Name:ICRR
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NEVIN
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-587-2300
Mailing Address - Street 1:4106 LOWER RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19056-3223
Mailing Address - Country:US
Mailing Address - Phone:267-587-2300
Mailing Address - Fax:
Practice Address - Street 1:4106 LOWER RD
Practice Address - Street 2:
Practice Address - City:NEWPORTVILLE
Practice Address - State:PA
Practice Address - Zip Code:19056-3223
Practice Address - Country:US
Practice Address - Phone:267-587-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness