Provider Demographics
NPI:1437132651
Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Other - Org Name:HAMBURG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-705-2774
Mailing Address - Street 1:3560 OLD RTE 22
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526
Mailing Address - Country:US
Mailing Address - Phone:610-562-6001
Mailing Address - Fax:610-562-6081
Practice Address - Street 1:3560 OLD RTE 22
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526
Practice Address - Country:US
Practice Address - Phone:610-562-6001
Practice Address - Fax:610-562-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PA100308518Medicaid
501748Medicare PIN