Provider Demographics
NPI:1376673202
Name:PENN FOUNDATION, INC.
Entity Type:Organization
Organization Name:PENN FOUNDATION, INC.
Other - Org Name:PENN FOUNDATION, INC. INTELLECTUAL DISABILITIES SUPPORTS COORDINATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:215-257-6551
Mailing Address - Street 1:807 LAWN AVE
Mailing Address - Street 2:P.O. BOX 32
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1549
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:215-257-9347
Practice Address - Street 1:64 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1159
Practice Address - Country:US
Practice Address - Phone:215-257-1183
Practice Address - Fax:215-257-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management