NPIMap

Organization Active NPI

Philhaven

Doing business as WellSpan Philhaven

  • Clinic/Center
  • Lebanon, PA
National Provider Identifier
1174629463
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PHILHAVEN
Doing business as
WellSpan Philhaven
Practice address
283 S Butler Rd
Lebanon, PA 17042-8939
Phone
(717) 270-2405
NPI assigned
Sep 15, 2006
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mantha Kotsalos
Title
VP & President Philhaven
Phone
(717) 270-2423

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

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 practice location 1

780 Eden Rd
Lancaster, PA 17601-4275
Phone (717) 735-7770

Other practice location 2

1407 Williams Rd
York, PA 17402-9000
Phone (717) 845-2482

Other names 2

  • WellSpan Philhaven Doing business as
  • WellSpan Philhaven Partial Hospital Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100910000406 PA Part A Provider - Hospital 8729991419 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: York, PA; Lebanon, PA; Lancaster, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174629463. Details of each certification follow.

Hospital certification: CCN 394020

Legal name
PHILHAVEN
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Jun 10, 2015
Beds
103
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
May 11, 1949 in PA
Enrollment address
283 S Butler Rd
Lebanon, PA 17042-8939
Hospital subgroups
Psychiatric

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Philhaven HospitalCCN 394020 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Philhaven Hospital Psyc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

1407 Williams Rd
York, PA 17402
Phone (717) 845-2482

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Buczkowski Individual Corporate OfficerSenior VP and Cfo Nov 30, 2020
W-2 Managing EmployeeSenior VP and Cfo Nov 30, 2020
Roxanna L Gapstur Individual OtherPresident, Wellspan Health Jan 2, 2019
Mantha Kotsalos Individual Corporate OfficerVP Behavioral Health Network Apr 23, 2024
W-2 Managing EmployeeVP Behavioral Health Network Apr 23, 2024
Robert Hoffman Individual Corporate Director Jan 1, 2021
Robert J Funk Individual Corporate Director Jan 1, 2021
Stephen a Lindsey Individual Corporate Director Jan 1, 2021
Christopher L Grant Individual Corporate Director Jan 1, 2021
Roger Zimmerman Individual Corporate Director Jan 1, 2021
Carrie Wilson Individual Corporate DirectorVice Chair Jan 1, 2021
Moniqua Acosta Individual Corporate OfficerChair Jan 1, 2021
Corporate Director Jul 1, 2013
Michael B Seim Individual Corporate DirectorEx-Officio Jan 1, 2021
Kimberly Shaun Kreider Umble Individual Corporate Director Jan 1, 2021
Wellspan Health Organization, York, PA Corporation, Non-profit Operational/Managerial Control Jan 1, 2016
Other Jan 1, 2016
Edward Joseph Tadajweski Individual Corporate Director Jan 1, 2021
James Stuccio Individual Corporate DirectorEx-Officio Jan 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1174629463",
    "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": "717-270-2405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "780 Eden Rd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176014275",
            "country_code": "US",
            "telephone_number": "717-735-7770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1407 Williams Rd",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174029000",
            "country_code": "US",
            "telephone_number": "717-845-2482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WellSpan Philhaven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellSpan Philhaven Partial Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.