Provider Demographics
NPI:1801243712
Name:EXCENTIA HUMAN SERVICES
Entity type:Organization
Organization Name:EXCENTIA HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-519-6740
Mailing Address - Street 1:1810 ROHRERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2322
Mailing Address - Country:US
Mailing Address - Phone:717-519-6740
Mailing Address - Fax:717-519-6746
Practice Address - Street 1:1810 ROHRERSTOWN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2322
Practice Address - Country:US
Practice Address - Phone:717-519-6740
Practice Address - Fax:717-519-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACER00075435251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017260108Medicaid