Provider Demographics
NPI:1710019096
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: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 A110
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:215-752-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
PA123890322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001996Medicaid
PA100001996Medicaid