Provider Demographics
NPI:1619303914
Name:KIDSPEACE NATIONAL CENTERS, OF PENNSYLVANIA INC.
Entity Type:Organization
Organization Name:KIDSPEACE NATIONAL CENTERS, OF PENNSYLVANIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-799-7517
Mailing Address - Street 1:4085 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2574
Mailing Address - Country:US
Mailing Address - Phone:610-799-8343
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:5300 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2044
Practice Address - Country:US
Practice Address - Phone:610-799-8000
Practice Address - Fax:610-799-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100763290-0041Medicaid