Provider Demographics
NPI:1750461455
Name:NORTH PENN COMPREHENSIVE HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTH PENN COMPREHENSIVE HEALTH SERVICES
Other - Org Name:MANSFIELD LAUREL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANZILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-662-1945
Mailing Address - Street 1:6A RIVERSIDE PLZ
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-1137
Mailing Address - Country:US
Mailing Address - Phone:570-662-1945
Mailing Address - Fax:
Practice Address - Street 1:416 S MAIN ST
Practice Address - Street 2:MANSFIELD LAUREL HEALTH CENTER
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1510
Practice Address - Country:US
Practice Address - Phone:570-662-2002
Practice Address - Fax:570-662-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000011720038Medicaid
PA103562Medicare ID - Type Unspecified
PA1000011720038Medicaid