Provider Demographics
NPI:1508081639
Name:PHILHAVEN
Entity Type:Organization
Organization Name:PHILHAVEN
Other - Org Name:WELLSPAN PHILHAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT WELLSPAN PHILHAVEN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-273-8871
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:283 S BUTLER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8939
Practice Address - Country:US
Practice Address - Phone:717-270-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007720000120Medicaid
PA1007720000148Medicaid
PA1007720000144Medicaid
PA1007720000147Medicaid
PA1007720000149Medicaid
PA1007720000150Medicaid
PA1007720000123Medicaid
PA1007720000150Medicaid
PA1007720000143Medicaid
PA1007720000147Medicaid