Organization
PHILHAVEN
Active
Other names
WellSpan Philhaven Intensive Behavioral Health Services, WellSpan Philhaven, WellSpan Philhaven Family Based
Organization subpart
No
Provider details
NPI number
Authorized official
MANTHA KOTSALOS (VP & PRESIDENT PHILHAVEN)
(717) 270-2423
Entity
Organization
Contact information
Practice address
283 S BUTLER RD, LEBANON, PA 17042-8939
(717) 270-2425
Mailing address
601 MEMORY LN, YORK, PA 17402-2231
(717) 851-1405
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007720000120
—
PA
05
—
1007720000123
—
PA
05
—
1007720000144
—
PA
05
—
1007720000147
—
PA
05
—
1007720000148
—
PA
05
—
1007720000149
—
PA
05
—
1007720000150
—
PA
Enumeration date
04/16/2007
Last updated
06/05/2024
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