Provider Demographics
NPI:1023288891
Name:PENNDEL MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:PENNDEL MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:267-587-2300
Mailing Address - Street 1:1723 WOODBOURNE RD
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1510
Mailing Address - Country:US
Mailing Address - Phone:267-587-2300
Mailing Address - Fax:267-587-2305
Practice Address - Street 1:1517 DURHAM RD
Practice Address - Street 2:
Practice Address - City:PENNDEL
Practice Address - State:PA
Practice Address - Zip Code:19047-5707
Practice Address - Country:US
Practice Address - Phone:215-752-1541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000019960012OtherPROMISE ID