Provider Demographics
NPI:1366508871
Name:POTTER COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:POTTER COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY COMMISSIONERS CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-274-8290
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:ROULETTE
Mailing Address - State:PA
Mailing Address - Zip Code:16746-0241
Mailing Address - Country:US
Mailing Address - Phone:814-544-7315
Mailing Address - Fax:814-544-9062
Practice Address - Street 1:62 NORTH ST.
Practice Address - Street 2:
Practice Address - City:ROULETTE
Practice Address - State:PA
Practice Address - Zip Code:16746-0241
Practice Address - Country:US
Practice Address - Phone:814-544-7315
Practice Address - Fax:814-544-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100733450251B00000X
PA1007334500006252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100733450Medicaid