Provider Demographics
NPI:1588052609
Name:PERSEUS HOUSE INC
Entity type:Organization
Organization Name:PERSEUS HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCTNG CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-480-5911
Mailing Address - Street 1:1511 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2104
Mailing Address - Country:US
Mailing Address - Phone:814-480-5900
Mailing Address - Fax:814-454-8670
Practice Address - Street 1:643 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1729
Practice Address - Country:US
Practice Address - Phone:814-452-2740
Practice Address - Fax:814-452-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100771390Medicaid