Provider Demographics
NPI:1932226669
Name:ADELPHOI VILLAGE, INC.
Entity Type:Organization
Organization Name:ADELPHOI VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE MANAGMENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-804-7159
Mailing Address - Street 1:1119 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5201
Mailing Address - Country:US
Mailing Address - Phone:724-520-1111
Mailing Address - Fax:724-520-1878
Practice Address - Street 1:1501 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2912
Practice Address - Country:US
Practice Address - Phone:724-805-0161
Practice Address - Fax:724-805-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA409300251K00000X, 251S00000X, 261Q00000X, 261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
100744730OtherCCBHO VENDOR NUMBER
328824OtherVBH PROVIDER NUMBER
PA1007447300021Medicaid
A983178OtherVBH VENDOR ID