Provider Demographics
NPI:1609001791
Name:PENNSYLVANIA PSYCHIATRIC INSTITUTE
Entity Type:Organization
Organization Name:PENNSYLVANIA PSYCHIATRIC INSTITUTE
Other - Org Name:ADULT PARTIAL PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-782-4742
Mailing Address - Street 1:PO BOX 826929
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-2351
Mailing Address - Country:US
Mailing Address - Phone:717-782-4783
Mailing Address - Fax:717-782-2351
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-6493
Practice Address - Fax:717-782-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA327640261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020963800006Medicaid
PA166859OtherMEDICARE B
PA394051OtherMEDICARE A
PA3A0787OtherCAPITAL BLUE CROSS
PA1632381OtherGATEWAY MEDIASSURED
PA2318OtherHIGHMARK