Provider Demographics
NPI:1700231297
Name:PROSPECT HEALTH ACCESS NETWORK, INC.
Entity Type:Organization
Organization Name:PROSPECT HEALTH ACCESS NETWORK, INC.
Other - Org Name:CROZER-KEYSTONE PSYCHIATRY UPLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:POB 1, SUITE 407
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-874-5257
Mailing Address - Fax:601-874-7241
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:POB 1, SUITE 407
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-874-5257
Practice Address - Fax:601-874-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty