Provider Demographics
NPI:1386626919
Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Other - Org Name:ALLENTOWN STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-740-3401
Mailing Address - Street 1:1600 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-2408
Mailing Address - Country:US
Mailing Address - Phone:610-740-3401
Mailing Address - Fax:610-740-3413
Practice Address - Street 1:1600 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2408
Practice Address - Country:US
Practice Address - Phone:610-740-3401
Practice Address - Fax:610-740-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PA692512Medicare ID - Type UnspecifiedCLINICAL SERVICES
PA394011Medicare Oscar/Certification