Provider Demographics
NPI:1063119063
Name:PENNSYLVANIA BEHAVIORAL HEALTH CENTER
Entity type:Organization
Organization Name:PENNSYLVANIA BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDT
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-431-6404
Mailing Address - Street 1:710 WHEATLAND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3988
Mailing Address - Country:US
Mailing Address - Phone:610-563-2752
Mailing Address - Fax:610-233-4342
Practice Address - Street 1:710 WHEATLAND ST STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3988
Practice Address - Country:US
Practice Address - Phone:610-563-2752
Practice Address - Fax:610-233-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149050OtherDEPARTMENT OF HUMAN SERVICES