Provider Demographics
NPI:1457334336
Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Other - Org Name:DANVILLE STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-772-2518
Mailing Address - Street 1:50 KIRKBRIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8630
Mailing Address - Country:US
Mailing Address - Phone:570-271-4510
Mailing Address - Fax:570-271-4514
Practice Address - Street 1:50 KIRKBRIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-8630
Practice Address - Country:US
Practice Address - Phone:570-271-4510
Practice Address - Fax:570-271-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100308518Medicaid
PACN0717Medicare PIN
PA394004Medicare Oscar/Certification
PA661632Medicare ID - Type UnspecifiedCLINICAL SERVICES