Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | 545510 | PENNSYLVANIA | No |
| 2 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | 555140 | PENNSYLVANIA | No |
| 3 | 315P00000X | Intermediate Care Facility, Intellectual Disabilities | | 629740 | PENNSYLVANIA | No |
| 4 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | 112030 | PENNSYLVANIA | No |
| 5 | 252Y00000X | Early Intervention Provider Agency | | | | No |
| 6 | 261QM0850X | Clinic/Center | Adult Mental Health | 142420 | PENNSYLVANIA | No |
| 7 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | 112030 | PENNSYLVANIA | Yes |
| 8 | 225X00000X | Occupational Therapist | | | | No |
| 9 | 225100000X | Physical Therapist | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 11500557 | OTHER | | KEYSTONE MERCY HEALTH PLA |
| 2 | 100001074 | MEDICAID | PENNSYLVANIA | |
| 3 | 1982651600 | MEDICARE UPIN | PENNSYLVANIA | |
| 4 | DA2402 | OTHER | | RAILROAD MEDICARE |
| 5 | LI1334230 | OTHER | | BLUE CROSS/BLUE SHIELD |
