Organization
PENN RESIDENTIAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE WILLIAMS (C.E.O.)
(724) 635-0048
Entity
Organization
Contact information
Practice address
PO BOX C, NEW STANTON, PA 15672-0417
(724) 635-0048
(724) 635-0746
Mailing address
PO BOX C, NEW STANTON, PA 15672-0417
(724) 635-0048
(724) 635-0746
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
444280
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102577794
—
PA
Enumeration date
01/11/2013
Last updated
01/11/2013
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