Provider Demographics
NPI:1811926918
Name:FAMILY SERVICES OF MONTGOMERY COUNTY PA
Entity type:Organization
Organization Name:FAMILY SERVICES OF MONTGOMERY COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-630-2111
Mailing Address - Street 1:3125 RIDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1407
Mailing Address - Country:US
Mailing Address - Phone:610-630-2111
Mailing Address - Fax:610-630-4003
Practice Address - Street 1:3125 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1407
Practice Address - Country:US
Practice Address - Phone:610-630-2111
Practice Address - Fax:610-630-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA659570Medicare PIN
PA658815Medicare PIN
PA665666Medicare ID - Type Unspecified