Philhaven

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PHILHAVEN

Practice address

283 S Butler Rd
Lebanon, PA 17042-8939

Phone

(717) 270-2405

NPI assigned

Sep 15, 2006

Organization subpart

No

Name

Mantha Kotsalos

Title

VP & President Philhaven

Phone

(717) 270-2423

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

• Edward Jospeh Tadajweski, M.D.

  • Cardiovascular Disease Physician
  • Lebanon, PA
  • NPI 1235280363
  CMS ownership Corporate Director

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

• Philhaven

  • Psychiatric Hospital Unit
  • Lebanon, PA
  • NPI 1265657381
  Same enrollment O20100910000406
• Philhaven

  • Clinic/Center
  • Lebanon, PA
  • NPI 1275758393
  Same enrollment O20100910000406
• Philhaven

  • Psychiatric Hospital
  • Lebanon, PA
  • NPI 1972598076
  Same enrollment O20100910000406

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

• Philhaven

  • Psychiatric Residential Treatment Facility
  • Mount Gretna, PA
  • NPI 1083020390
  NPD tax ID
• Philhaven

  • Psychiatric Residential Treatment Facility
  • Lebanon, PA
  • NPI 1205051281
  NPD tax ID
• Philhaven

  • Psychiatric Hospital Unit
  • Lebanon, PA
  • NPI 1265657381
  NPD tax ID
• Philhaven

  • Psychiatric Hospital
  • Mt Gretna, PA
  • NPI 1417172545
  NPD tax ID
• Philhaven

  • Clinic/Center
  • Lebanon, PA
  • NPI 1508081639
  NPD tax ID
• Philhaven

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mt Gretna, PA
  • NPI 1528283678
  NPD tax ID
• Philhaven

  • Pharmacy
  • Lebanon, PA
  • NPI 1578680989
  NPD tax ID
• Philhaven

  • Psychiatric Hospital
  • Mt Gretna, PA
  • NPI 1780809806
  NPD tax ID
• Philhaven

  • Psychiatric Hospital
  • Lancaster, PA
  • NPI 1871973156
  NPD tax ID
• Philhaven

  • Public Health or Welfare Agency
  • Lebanon, PA
  • NPI 1952526089
  NPD tax ID
• Philhaven

  • Psychiatric Hospital
  • Lebanon, PA
  • NPI 1972598076
  NPD tax ID
• Philhaven Residential

  • Psychiatric Residential Treatment Facility
  • Lebanon, PA
  • NPI 1487878773
  NPD tax ID
• Philhaven Residential

  • Psychiatric Residential Treatment Facility
  • Palmyra, PA
  • NPI 1972727238
  NPD tax ID
• Wellspan Philhaven Residential

  • Psychiatric Residential Treatment Facility
  • Mt Gretna, PA
  • NPI 1013132992
  NPD tax ID

Listed as

Philhaven HospitalCCN 394020

Type

Psychiatric

Ownership

Voluntary non-profit - Church

Medicare certification status

Active (Provider of Services file)

Emergency services

No

Medicare fee-for-service enrollment

Enrolled in PA

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

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

Tax ID family

Philhaven Residential (15 organizations share this tax ID)

Locations

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 5, 2024.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000054",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000145",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000115",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000037",
            "state": "PA"
        }
    ],
    "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"
        }
    ]
}

• Kathleen Goddard Petzold, PHARMD
• Cecelia S Pharris, LCSW
• Sereyvisale Pheng, PHARMD
• Seth Pheng
• Philhaven
• Philhaven
• Philhaven
• Philhaven
• Philhaven
• Philhaven

• All providers in Lebanon, PA
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.