Organization
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Active
Parent organization
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Other names
Laurel Behavioral Health Outpatient
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Authorized official
ANGELA M. VANZILE (CREDENTIALING COORDINATOR)
(570) 662-1945
Entity
Organization
Contact information
Practice address
40 W WELLSBORO ST, MANSFIELD, PA 16933-1411
(570) 723-0620
Mailing address
40 W WELLSBORO ST, MANSFIELD, PA 16933-1411
(570) 662-1945
(570) 662-2390
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000011720142
—
PA
01
—
103562
MEDICARE PART B
PA
01
—
391056
MEDICARE PART A
PA
Enumeration date
06/01/2015
Last updated
04/18/2023
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