Provider Demographics
NPI:1043316441
Name:PHILHAVEN
Entity type:Organization
Organization Name:PHILHAVEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & PRESIDENT PHILHAVEN
Authorized Official - Prefix:
Authorized Official - First Name:MANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTSALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-2423
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:283 S BUTLER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8939
Practice Address - Country:US
Practice Address - Phone:717-270-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA178791Medicare ID - Type UnspecifiedPART B HGSA