Provider Demographics
NPI:1144888272
Name:PERSEUS HOUSE, INC
Entity type:Organization
Organization Name:PERSEUS HOUSE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-480-5911
Mailing Address - Street 1:1511 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2104
Mailing Address - Country:US
Mailing Address - Phone:814-480-5911
Mailing Address - Fax:814-454-8670
Practice Address - Street 1:516 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1333
Practice Address - Country:US
Practice Address - Phone:814-453-6389
Practice Address - Fax:814-879-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100771390Medicaid