Penn Residential, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

444280 Issued in PA

Legal business name

PENN RESIDENTIAL, INC.

Practice address

PO Box C
New Stanton, PA 15672-0417

Phone

(724) 635-0048

Fax

(724) 635-0746

NPI assigned

Jan 11, 2013

Organization subpart

No

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

Authorized official

Name

Clyde Williams

Title

C.E.O.

Phone

(724) 635-0048

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357862400000",
    "number": "1689911554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX C",
            "city": "NEW STANTON",
            "state": "PA",
            "postal_code": "156720417",
            "telephone_number": "724-635-0048",
            "fax_number": "724-635-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX C",
            "city": "NEW STANTON",
            "state": "PA",
            "postal_code": "156720417",
            "telephone_number": "724-635-0048",
            "fax_number": "724-635-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN RESIDENTIAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "724-635-0048"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "PA",
            "license": "444280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102577794",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Billie Jo Lewis, L.P.C.
• James C.a. Mack, DDS
• New Stanton Chiropractic
• New Stanton Primary Care
• Orndoff Podiatry, P.C.
• Michael Richard Podolinski, NP-C
• Ramesh P Patel MD
• Ristway Inc
• Ristway Inc
• Gina Marie Skinner, CRNP

• Emotionally Disturbed Childrens' Residential Treatment Facility in New Stanton, PA
• Providers in New Stanton, PA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.