Provider Demographics
NPI: | 1508983289 |
---|---|
Name: | ADELPHOI VILLAGE |
Entity Type: | Organization |
Organization Name: | ADELPHOI VILLAGE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REVENUE CYCLE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | LEIGH |
Authorized Official - Last Name: | HERSHBERGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 724-804-7193 |
Mailing Address - Street 1: | 1119 VILLAGE WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | LATROBE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15650 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 724-520-1111 |
Mailing Address - Fax: | 724-520-1878 |
Practice Address - Street 1: | 1119 VILLAGE WAY |
Practice Address - Street 2: | |
Practice Address - City: | LATROBE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15650 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-520-1111 |
Practice Address - Fax: | 724-520-1878 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-26 |
Last Update Date: | 2020-11-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YM0800X, 101YP2500X, 103TH0004X, 106H00000X | ||
PA | 423910 | 103T00000X, 2084F0202X, 2084N0400X, 2084P0005X, 251K00000X, 251S00000X, 261Q00000X, 261QM0801X, 261QM0855X, 323P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Single Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Single Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty | |
No | 2084F0202X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry | Group - Single Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |
No | 2084P0005X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities | Group - Single Specialty |
No | 251K00000X | Agencies | Public Health or Welfare | Group - Single Specialty | |
No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Single Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Single Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Single Specialty |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | Group - Single Specialty |