NPIMap

Organization Active NPI

Pennsylvania Department of Human Services

Doing business as Polk Center

  • Intellectual Disabilities Intermediate Care Facility
  • Polk, PA
National Provider Identifier
1851374698
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Doing business as
Polk Center
Practice address
1 Lakewood Circle
Polk, PA 16342
Phone
(814) 432-0211
Fax
(814) 432-0186
NPI assigned
Nov 25, 2005
Last updated
Oct 4, 2021By the provider in NPPES
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) 772-2518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

1 Lakewood Circle
Polk, PA 16342

Mailing address

1 Lakewood Circle
Polk, PA 16342
Phone (814) 432-0211

Other names 1

  • Polk Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000722 PA Part B Supplier - Clinic/Group Practice 0547168064 Receives reassigned benefits from 6 practitioners
Practice locations: Polk, PA

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
PA Dept of Public Welfa16 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

1 Lakewood Cir N
Polk, PA 16342
Phone (814) 432-0211

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Warren State HospitalNorth Warren, PA, CCN 394016 Hospital Operational/Managerial Control Jan 1, 1966
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 7

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1851374698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LAKEWOOD CIRCLE",
            "city": "POLK",
            "state": "PA",
            "postal_code": "16342",
            "telephone_number": "814-432-0211",
            "fax_number": "814-432-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LAKEWOOD CIRCLE",
            "city": "POLK",
            "state": "PA",
            "postal_code": "16342",
            "telephone_number": "814-432-0211",
            "fax_number": "814-432-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-25",
        "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": "717-772-2518"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Polk Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polk, PA

Sources for this page

Verify at the official NPI Registry.