Provider Demographics
NPI:1376526111
Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Other - Org Name:TORRANCE STATE HOSPITAL
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:STATE ROUTE 1014
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15779-0111
Mailing Address - Country:US
Mailing Address - Phone:724-459-4511
Mailing Address - Fax:724-459-4498
Practice Address - Street 1:STATE ROUTE 1014
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779-0111
Practice Address - Country:US
Practice Address - Phone:724-459-4511
Practice Address - Fax:724-459-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PA394026Medicare Oscar/Certification
PAC31363Medicare PIN
PA100308518Medicaid