Philhaven
Organization Active NPI Psychiatry Physician · Lebanon, PA
NPI 1043316441 · NPPES record last updated Jun 5, 2024
Key facts
- NPI
- 1043316441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- PHILHAVEN
- Practice address
- 283 S Butler Rd
Lebanon, PA 17042-8939 - Phone
- (717) 270-2443
- NPI assigned
- Sep 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Mantha Kotsalos
- Title
- VP & President Philhaven
- Phone
- (717) 270-2423
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 164
-
Theresa Ngozi Adigwu, CRNP
-
Benjamin Armon, MD
-
Denise N Batuuka, MD
-
Gwendolyn K Blankenship, LCSW
-
Brittany Dancy Caro, PHD
-
Judith J Clark, LPC
-
Kelsey Daubert, MA, LPC
-
Frank Joseph Dibella, MA, LPC
-
Jaime M Dickinson, MSW, LCSW
-
John Francis Dolena, D.O.
-
Jane Ellen Fanslow, MS, LPC
-
Ana Linn Filippo, LSW
-
Anna Fisher, PSY.D.
-
Albert Fombu, M.D
-
Michael A Fueyo, MD
-
Nidhi Garg, MD
-
Meryl Reist Gibbel, PHD
-
Gillian Grannum, PHD
-
Lydia B Hackenberg, PSYD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000103 | PA | Part B Supplier - Clinic/Group Practice | 8729991419 |
Receives reassigned benefits from 156 practitioners 2 other NPIs on this enrollment Practice locations: Lebanon, PA; Lancaster, PA; Ephrata, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
283 S Butler Rd
Lebanon, PA 17042-8939
Mailing address
601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405
Other names
- WellSpan Philhaven
NPI Registry JSON
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1717545600000",
"number": "1043316441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 MEMORY LN",
"city": "YORK",
"state": "PA",
"postal_code": "174022231",
"telephone_number": "717-851-1405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "283 S BUTLER RD",
"city": "LEBANON",
"state": "PA",
"postal_code": "170428939",
"telephone_number": "717-270-2443"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHILHAVEN",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-15",
"last_updated": "2024-06-05",
"certification_date": "2024-06-05",
"status": "A",
"authorized_official_last_name": "KOTSALOS",
"authorized_official_first_name": "MANTHA",
"authorized_official_title_or_position": "VP & PRESIDENT PHILHAVEN",
"authorized_official_telephone_number": "717-270-2423"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "WellSpan Philhaven",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lebanon, PA
- Anthony Salvadore Petrole
- Kathleen Goddard Petzold
- Cecelia S Pharris
- Sereyvisale Pheng
- Seth Pheng
- Philhaven
- Philhaven
- Philhaven
- Philhaven
- Philhaven
All providers in Lebanon, PA · Psychiatry Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.