Provider Demographics
NPI:1740319326
Name:PERRY HUMAN SERVICES
Entity type:Organization
Organization Name:PERRY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENYS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILISSIO
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:717-582-8703
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-0436
Mailing Address - Country:US
Mailing Address - Phone:717-582-8703
Mailing Address - Fax:717-582-3694
Practice Address - Street 1:8391 SPRING ROAD
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068
Practice Address - Country:US
Practice Address - Phone:717-582-8703
Practice Address - Fax:717-582-3694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA501025251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA501025OtherDRUG ALCOHOL OUTPATIENT
PA0012162940002Medicaid