NPIMap

Organization Active NPI

Pennsylvania Department of Human Services

  • Psychiatric Hospital
  • North Warren, PA
National Provider Identifier
1790768471
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Practice address
33 Main Dr
North Warren, PA 16365-5001
Phone
(814) 726-4258
Fax
(814) 726-4378
NPI assigned
Nov 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Authorized official

Name
Kathy Light
Title
Administrator
Phone
(717) 772-2517

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary
Institutional Pharmacy 3336I0012X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

33 Main Dr
North Warren, PA 16365-5001

Mailing address

33 Main Dr
North Warren, PA 16365-5001
Phone (814) 726-4258

Other identifiers 1

IdentifierTypeStateIssuer
100308518MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041207000650 PA Part B Supplier - Clinic/Group Practice 0547168064 Receives reassigned benefits from 25 practitioners
Practice locations: North Warren, PA
O20061002000043 PA Part A Provider - Hospital 0547168064 Practice locations: North Warren, PA

Hospital certification: CCN 394016

Legal name
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Doing business as
WARREN STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Dec 4, 2023
Beds
186
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
33 Main Dr
North Warren, PA 16365-5001
Main/Primary Hospital Location
Hospital subgroups
Psychiatric unit

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Warren State HospitalCCN 394016
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0892708Warren State Hospital33 Main Drive, Warren, PA 16365Certificate of waiverJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Haverford State Hosp16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

625 Forster St
Rm 605
Harrisburg, PA 17120

33 Main Dr
Warren, PA 16365
Phone (814) 723-5500

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jeffrey Darling Individual W-2 Managing Employee Apr 16, 2022
Operational/Managerial ControlNursing Director Apr 16, 2022
Pennsylvania Department of Human Services Organization, North Warren, PA Operational/Managerial Control Jan 1, 1966
Amber Baldensperger Individual W-2 Managing EmployeeChief Social Rehab Executive Jun 20, 2015
Operational/Managerial ControlDirector Social & Rehabilitation Jun 20, 2015
Christopher Crawford Individual W-2 Managing Employee Nov 10, 2014
Terry Crambes Individual W-2 Managing EmployeeCoo May 5, 2018
Operational/Managerial ControlCoo May 5, 2018
Trudy Johnson Individual W-2 Managing Employee Dec 23, 2023
Operational/Managerial ControlQa/RM Director Dec 23, 2023
Andrea J Richard Individual W-2 Managing EmployeeChief Medical Officer Jul 15, 2017
Operational/Managerial ControlChief Medical Officer Jul 15, 2017
Kathy Light Individual W-2 Managing Employee Jul 1, 2016
Operational/Managerial ControlAdministrator,Dept of Human Serv Nov 22, 2021
David Markley Individual W-2 Managing EmployeeChief Performance Improvement Ex Oct 23, 2010
Operational/Managerial ControlState Facility Director, DHS Oct 23, 2010

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wernersville State HospitalWernersville, PA, CCN 394014 Hospital Operational/Managerial Control Feb 10, 2007
Danville State HospitalDanville, PA, CCN 394004 Hospital Operational/Managerial Control Dec 31, 2011
Norristown State HospitalNorristown, PA, CCN 394001 Hospital Operational/Managerial Control Jul 12, 1966
Pennsylvania Department of Human ServicesClarks Summit, PA, CCN 394012 Hospital Operational/Managerial Control Dec 24, 2014
Torrance State HospitalTorrance, PA, CCN 394026 Hospital Operational/Managerial Control (100%) Jul 1, 1966
South Mountain Restoration CenterSouth Mountain, PA, CCN 395583 Skilled nursing facility Adp of the SNF Sep 15, 2025

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1790768471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 MAIN DR",
            "city": "NORTH WARREN",
            "state": "PA",
            "postal_code": "163655001",
            "telephone_number": "814-726-4258",
            "fax_number": "814-726-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MAIN DR",
            "city": "NORTH WARREN",
            "state": "PA",
            "postal_code": "163655001",
            "telephone_number": "814-726-4258",
            "fax_number": "814-726-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-28",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "LIGHT",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "717-772-2517"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100308518",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Warren, PA

Sources for this page

Verify at the official NPI Registry.