Organization
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Active
Other names
Polk Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY LIGHT (ADMINISTRATOR)
(717) 772-2518
Entity
Organization
Contact information
Practice address
1 LAKEWOOD CIRCLE, POLK, PA 16342
(814) 432-0211
(814) 432-0186
Mailing address
1 LAKEWOOD CIRCLE, POLK, PA 16342
(814) 432-0211
(814) 432-0186
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100308518
—
PA
Enumeration date
11/25/2005
Last updated
10/04/2021
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