Provider Demographics
NPI:1548483282
Name:COUNTY OF MONTGOMERY
Entity type:Organization
Organization Name:COUNTY OF MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-278-3642
Mailing Address - Street 1:1430 DEKALB ST
Mailing Address - Street 2:P.O. BOX 311 HSC MHMR
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1430 DEKALB ST
Practice Address - Street 2:HSC MHMR
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3406
Practice Address - Country:US
Practice Address - Phone:610-278-3642
Practice Address - Fax:610-278-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Not Answered251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000072290023Medicaid