Edgewater Psychiatric Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EDGEWATER PSYCHIATRIC CENTER

Practice address

295 State Dr
Elizabethville, PA 17023-8661

Phone

(215) 836-3131

NPI assigned

Apr 13, 2007

Last updated

Aug 5, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Norman Tilson Jr.

Title

Director of Business Operations

Phone

(215) 836-3131

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249430400000",
    "number": "1275757692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4391 STURBRIDGE DR",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171103673",
            "telephone_number": "215-836-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 STATE DR",
            "city": "ELIZABETHVILLE",
            "state": "PA",
            "postal_code": "170238661",
            "telephone_number": "215-836-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER PSYCHIATRIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2009-08-05",
        "status": "A",
        "authorized_official_last_name": "TILSON",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "215-836-3131",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007457920019",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007457920011",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Elizabethville, PA
• Providers in Elizabethville, PA by specialty
• Community/Behavioral Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.