Provider Demographics
NPI:1811387194
Name:PHILIP J. ERDOS
Entity Type:Organization
Organization Name:PHILIP J. ERDOS
Other - Org Name:PROFESSIONAL HABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:ERDOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS BA
Authorized Official - Phone:724-269-7030
Mailing Address - Street 1:8484B SHARON MERCER RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-3140
Mailing Address - Country:US
Mailing Address - Phone:724-269-7030
Mailing Address - Fax:724-269-7030
Practice Address - Street 1:8484B SHARON MERCER RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-3140
Practice Address - Country:US
Practice Address - Phone:724-269-7030
Practice Address - Fax:724-269-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003471Medicaid