Provider Demographics
NPI:1104061118
Name:LIU #12 SCHOOL BASED PARTIAL HOSPITALIZATION PROGRAM
Entity type:Organization
Organization Name:LIU #12 SCHOOL BASED PARTIAL HOSPITALIZATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:717-252-3676
Mailing Address - Street 1:320 CHESTNUT ST
Mailing Address - Street 2:WRIGHTSVILLE ELEMENTARY SCHOOL
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17368-1521
Mailing Address - Country:US
Mailing Address - Phone:717-252-3676
Mailing Address - Fax:717-781-5897
Practice Address - Street 1:320 CHESTNUT ST
Practice Address - Street 2:WRIGHTSVILLE ELEMENTARY SCHOOL
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-1521
Practice Address - Country:US
Practice Address - Phone:717-252-3676
Practice Address - Fax:717-781-5897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN INTERMEDIATE UNIT # 12
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA326130251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA326130OtherDEPARTMENT OF PUBLIC WELFARE