Provider Demographics
NPI:1396880621
Name:CHILDREN'S HOME OF YORK
Entity type:Organization
Organization Name:CHILDREN'S HOME OF YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-755-1033
Mailing Address - Street 1:77 SHOE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HELLAM
Mailing Address - State:PA
Mailing Address - Zip Code:17406-8025
Mailing Address - Country:US
Mailing Address - Phone:717-755-1033
Mailing Address - Fax:717-755-9993
Practice Address - Street 1:77 SHOE HOUSE RD
Practice Address - Street 2:
Practice Address - City:HELLAM
Practice Address - State:PA
Practice Address - Zip Code:17406
Practice Address - Country:US
Practice Address - Phone:717-755-1033
Practice Address - Fax:717-755-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA327620253J00000X
PA303660261QM0801X
PA320980261QM0855X, 252Y00000X, 251S00000X
PA316860323P00000X
PA6770583245S0500X
PA359490322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No252Y00000XAgenciesEarly Intervention Provider Agency
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100729162Medicaid