Provider Demographics
NPI:1265724959
Name:PENNDEL MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:PENNDEL MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-587-2300
Mailing Address - Street 1:2005 CABOT BLVD
Mailing Address - Street 2:SUITE100
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1898
Mailing Address - Country:US
Mailing Address - Phone:267-587-2300
Mailing Address - Fax:267-587-2368
Practice Address - Street 1:2005 CABOT BLVD
Practice Address - Street 2:SUITE100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1898
Practice Address - Country:US
Practice Address - Phone:267-587-2300
Practice Address - Fax:267-587-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001996Medicaid
PA100001996Medicaid