Philhaven

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) 270-2422

Fax

(717) 279-2792

NPI assigned

Apr 16, 2007

Last updated

Oct 18, 2024By 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

Mantha Kotsalos

Title

VP & President Philhaven

Phone

(717) 270-2423

Specialties & licenses 2

Addresses

Other identifiers 12

Other names 2

• WellSpan Philhaven Doing business as
• WellSpan Philhaven Outpatient Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275758393. Details of each certification follow.

• CCN 394020 Hospital · Active · Details

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 4

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

• Philhaven

  dba WellSpan Philhaven

  • Psychiatry Physician
  • Lebanon, PA
  • NPI 1043316441

  O20031110000103

  Same enrollment
• Philhaven

  dba WellSpan Philhaven

  • Clinic/Center
  • Lebanon, PA
  • NPI 1174629463

  O20100910000406

  Same enrollment
• Philhaven

  dba WellSpan Philhaven

  • Psychiatric Hospital Unit
  • Lebanon, PA
  • NPI 1265657381

  O20100910000406

  Same enrollment
• Philhaven

  dba WellSpan Philhaven

  • Psychiatric Hospital
  • Lebanon, PA
  • NPI 1972598076

  O20031110000103, O20100910000406

  Same enrollment

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

Locations

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.

Owners & managing parties with NPI records 1

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

  Corporate Director

  CMS ownership

Practitioners 69

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melanie A Baer, PSY D

  • Psychologist
  • Lebanon, PA
  • NPI 1053491407
  NPD
• Andrew Bowen

  • Clinical Psychologist
  • Ephrata, PA
  • NPI 1053121004
  NPD
• Stevie Casalino, LSW

  • Clinical Social Worker
  • Lancaster, PA
  • NPI 1487305538
  NPD
• Letitia Alida Covaci, MD

  • Psychiatry Physician
  • Lancaster, PA
  • NPI 1316069560
  NPD
• Jamie Devoe, LPC

  • Professional Counselor
  • Lancaster, PA
  • NPI 1215571401
  NPD
• Frank Joseph Dibella, MA, LPC

  • Professional Counselor
  • Lancaster, PA
  • NPI 1841586690
  NPD
• Jaime M Dickinson, MSW, LCSW

  • Clinical Social Worker
  • Lebanon, PA
  • NPI 1871727982
  NPD
• John Francis Dolena, D.O.

  • Child & Adolescent Psychiatry Physician
  • Ephrata, PA
  • NPI 1619195070
  NPD
• Valerie Dorcelus, MD

  • Psychiatry Physician
  • York, PA
  • NPI 1720583594
  NPD
• Paul R Dorgan, MA, MPSY

  • Psychologist
  • Lancaster, PA
  • NPI 1568542983
  NPD
• Amber Autumn Farward, MA

  • Professional Counselor
  • Lancaster, PA
  • NPI 1821668278
  NPD
• Ana Linn Filippo, LSW

  • Clinical Social Worker
  • Lancaster, PA
  • NPI 1114241080
  NPD

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1275758393",
    "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": "717-270-2422",
            "fax_number": "717-279-2792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Eden Rd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176014712",
            "country_code": "US",
            "telephone_number": "717-399-7379",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "17042",
            "country_code": "US",
            "telephone_number": "717-274-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "344 N Reading Rd",
            "address_purpose": "LOCATION",
            "city": "Ephrata",
            "state": "PA",
            "postal_code": "175221651",
            "country_code": "US",
            "telephone_number": "717-738-1125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "239 S Butler Rd",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170428939",
            "country_code": "US",
            "telephone_number": "717-270-2422",
            "fax_number": "717-279-2792",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 Landis Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175438432",
            "country_code": "US",
            "telephone_number": "717-626-3703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "964 Isabel Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427482",
            "country_code": "US",
            "telephone_number": "717-274-9777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1886 Rohrerstown Rd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176012322",
            "country_code": "US",
            "telephone_number": "717-735-1920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 W Orange St",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175431814",
            "country_code": "US",
            "telephone_number": "717-735-1954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 Maple St",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175431425",
            "country_code": "US",
            "telephone_number": "717-626-3701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "418 E Lexington Rd",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175438963",
            "country_code": "US",
            "telephone_number": "717-626-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 N Oak St",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175431350",
            "country_code": "US",
            "telephone_number": "717-626-3705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175431950",
            "country_code": "US",
            "telephone_number": "717-626-3702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2501 Oregon Pike",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176014890",
            "country_code": "US",
            "telephone_number": "717-735-1954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426726",
            "country_code": "US",
            "telephone_number": "717-273-9391 x1505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 N 8th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170464719",
            "country_code": "US",
            "telephone_number": "717-273-9391 x2504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "499 E Pershing Ave",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170427640",
            "country_code": "US",
            "telephone_number": "717-675-2163",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Woodland St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426563",
            "country_code": "US",
            "telephone_number": "717-675-2173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 Old Forge Rd",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170467951",
            "country_code": "US",
            "telephone_number": "717-273-9391",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 E Lehman St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170463934",
            "country_code": "US",
            "telephone_number": "717-273-9391 x4518",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170425221",
            "country_code": "US",
            "telephone_number": "717-675-2138 x3104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHILHAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-14",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000076",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000135",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000133",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000138",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000132",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
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        },
        {
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            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000127",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
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            "identifier": "1007720000136",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000131",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007720000152",
            "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",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WellSpan Philhaven Outpatient",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Seth Pheng
• Philhaven (WellSpan Philhaven)
• Philhaven (WellSpan Philhaven)
• Philhaven
• Philhaven (WellSpan Philhaven)
• Philhaven (WellSpan Philhaven)
• Philhaven (WellSpan Philhaven)
• Philhaven (WellSpan Philhaven)
• Philhaven (WellSpan Philhaven)
• Philhaven Residential

• Clinic/Center in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.