Organization
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY LIGHT (ADMINISTRATOR)
(717) 772-2517
Entity
Organization
Contact information
Practice address
33 MAIN DR, NORTH WARREN, PA 16365-5001
(814) 726-4258
(814) 726-4378
Mailing address
33 MAIN DR, NORTH WARREN, PA 16365-5001
(814) 726-4258
(814) 726-4378
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100308518
—
PA
Enumeration date
11/28/2005
Last updated
10/04/2021
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