Provider Demographics
NPI:1780853994
Name:MERAKEY PENNSYLVANIA
Entity Type:Organization
Organization Name:MERAKEY PENNSYLVANIA
Other - Org Name:NORTHWESTERN HUMAN SERVICES OF PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-836-3131
Mailing Address - Street 1:4391 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3673
Mailing Address - Country:US
Mailing Address - Phone:215-836-3131
Mailing Address - Fax:215-273-5975
Practice Address - Street 1:224 N BOWER ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-2636
Practice Address - Country:US
Practice Address - Phone:215-836-3131
Practice Address - Fax:215-273-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017440175Medicaid