Pennsylvania Department of Human Services
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Polk, PA
NPI 1851374698 · NPPES record last updated Oct 4, 2021
Key facts
- NPI
- 1851374698
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- Legal business name
- PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
- Practice address
- 1 Lakewood Circle
Polk, PA 16342 - Phone
- (814) 432-0211
- Fax
- (814) 432-0186
- NPI assigned
- Nov 25, 2005
- Organization subpart
- No
Authorized official
- Name
- Kathy Light
- Title
- Administrator
- Phone
- (717) 772-2518
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 15
Practitioners 44
-
Edward J Ausman, D.O.
-
Eileen P Neely, MD
-
Renato P Ramirez, MD
-
Roy W Warren Jr., DO
-
Yevgeniy Suvorov, M.D.
-
Odezza Agustin Bautista, M.D.
-
Usha A Bhargave, MD
-
Malorie L. Budman, D.O.
-
Madeline Ann Danny, D.O
-
Martin Hudzinski, M.D.
-
Alexander J. Klufas, M.D.
-
Michael D Lance, MD
-
Lisa A Lewis, CRNP
-
Danny Liu, M.D.
-
Marsha E Modery, MD
-
Cheryl Moore, D.O.
-
Matthew Murnin, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Warren State Hospital |
Hospital | Operational/Managerial Control | Jan 1, 1966 |
| Wernersville State Hospital |
Hospital | Operational/Managerial Control | Feb 10, 2007 |
| Danville State Hospital |
Hospital | Operational/Managerial Control | Dec 31, 2011 |
| Norristown State Hospital |
Hospital | Operational/Managerial Control | Jul 12, 1966 |
| Pennsylvania Department of Human Services |
Hospital | Operational/Managerial Control | Dec 24, 2014 |
| Torrance State Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| South Mountain Restoration Center |
Skilled nursing facility | Adp of the SNF | Sep 15, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040301000722 | PA | Part B Supplier - Clinic/Group Practice | 0547168064 |
Receives reassigned benefits from 6 practitioners Practice locations: Polk, PA |
National Provider Directory
- Tax ID family
- Haverford State Hosp
Locations
1 Lakewood Cir N
Polk, PA 16342
Phone (814) 432-0211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | Yes |
Addresses
Primary practice location
1 Lakewood Circle
Polk, PA 16342
Mailing address
1 Lakewood Circle
Polk, PA 16342
Phone (814) 432-0211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100308518 | Medicaid | PA |
Other names
- Polk Center
Other providers in Polk, PA
- Zachery Allen Baughman
- Community Birth Group
- Carol Couvrette
- Family Service and Children'S Aid Society of Venango County
- National Birth Centers, Inc.
- Private Healthcare Facilities
- Matthew Shaffer
All providers in Polk, PA · Intellectual Disabilities Intermediate Care Facility in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.