Organization
ADELPHOI VILLAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA MALDET (DIRECTOR OF REVENUE CYCLE MANAGMENT)
(724) 804-7159
Entity
Organization
Contact information
Practice address
1501 LIGONIER ST, LATROBE, PA 15650-2912
(724) 805-0161
(724) 805-0166
Mailing address
1119 VILLAGE WAY, LATROBE, PA 15650-5201
(724) 520-1111
(724) 520-1878
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
409300
PA
251S00000X
Community/Behavioral Health Agency
409300
PA
261Q00000X
Clinic/Center
409300
PA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
409300
PA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
409300
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100744730
CCBHO VENDOR NUMBER
—
05
—
1007447300021
—
PA
01
—
328824
VBH PROVIDER NUMBER
—
01
—
A983178
VBH VENDOR ID
—
Enumeration date
03/26/2007
Last updated
11/02/2020
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