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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	DICKINSON CENTER INC
Address:	43 SERVIDEA DR RIDGWAY, PA 15853-6333
Phone:	(814) 776-2145
Fax:	(814) 776-2146
E-mail:	lchilds@journeyhealth.org
Web Site:	www.dickinsoncenter.org

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	DICKINSON CENTER, INC.
Address:	43 SERVIDEA DR RIDGWAY, PA 15853-6333
Phone:	(814) 776-2145
Fax:	(814) 776-1470


Type:	Regional/Field Office	Counties Served:	Cameron, Elk, McKean, Potter
Name:	DICKINSON CENTER, INC.
Address:	43 SERVIDEA DR RIDGWAY, PA 15853-6333
Phone:	(814) 776-2145
Fax:	(814) 776-1470

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Cameron/Elk
\|Service Name / Level	\|Rate

Benefits Counseling	$13.36 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Life Sharing-1 per-Elig-NG 2-by Relative > 30 Hrs	$204.29 / 1 Day
Life Sharing-1 per-Elig-NG 3-By Relative > 30 Hrs	$279.58 / 1 Day
Life Sharing-1 per-Elig-NG 4-by Relative > 30 Hrs	$355.61 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-5-8 Person-NG 1-Elig	$267.15 / 1 Day
Res Hab-5-8 Person-NG 1-Elig-w/Day Supports	$212.03 / 1 Day
Res Hab-5-8 Person-NG 2-Elig	$311.99 / 1 Day
Res Hab-5-8 Person-NG 2-Elig-w/Day Supports	$250.71 / 1 Day
Res Hab-5-8 Person-NG 3-Elig	$360.24 / 1 Day
Res Hab-5-8 Person-NG 3-Elig-w/Day Supports	$314.42 / 1 Day
Res Hab-5-8 Person-NG 4-Elig	$429.04 / 1 Day
Res Hab-5-8 Person-NG 4-Elig-w/Day Supports	$338.58 / 1 Day
Res Hab-Lic-2 Person-Inelig	$47.38 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Res Hab-Lic-5-8 Person-Inelig	$17.86 / 1 Day
Small Group Employment (Level 2)-15 min	$6.96 / 15 min.
Small Group Employment (Level 3)-15 Mins	$13.15 / 15 min.
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$17.91 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.

County : McKean
\|Service Name / Level	\|Rate

CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Life Sharing-1 per-Elig-NG 3-By Relative > 30 Hrs	$279.58 / 1 Day
Life Sharing-1 per-Elig-NG 4-by Relative > 30 Hrs	$355.61 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.

County : Potter
\|Service Name / Level	\|Rate

Benefits Counseling	$13.36 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3 Enh)	$23.74 / 15 min.
Life Sharing-1 per-Elig-NG 4-by Relative > 30 Hrs	$355.61 / 1 Day
Life Sharing-1 person-Elig-NG 1 > 30 Hrs	$171.35 / 1 Day
Life Sharing-1 person-Elig-NG 2 > 30 Hrs	$204.29 / 1 Day
Life Sharing-1 person-Elig-NG 3 > 30 Hrs	$279.58 / 1 Day
Life Sharing-1 person-Elig-NG 4 > 30 Hrs	$355.61 / 1 Day
Life Sharing-2 person-Elig-NG 1 > 30 Hrs	$120.79 / 1 Day
Life Sharing-2 person-Elig-NG 2 > 30 Hrs	$144.84 / 1 Day
Life Sharing-2 person-Elig-NG 3 > 30 Hrs	$197.06 / 1 Day
Life Sharing-2 person-Elig-NG 4 > 30 Hrs	$237.16 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Small Group Employment (Base)-15 min	$2.30 / 15 min.
Small Group Employment (Level 1)-15 min	$3.54 / 15 min.
Small Group Employment (Level 2)-15 min	$6.96 / 15 min.
Small Group Employment (Level 3)-15 Mins	$13.15 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$17.91 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.

County : Tioga
\|Service Name / Level	\|Rate

CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-5-8 Person-NG 1-Elig	$267.15 / 1 Day
Res Hab-5-8 Person-NG 1-Elig-w/Day Supports	$212.03 / 1 Day
Res Hab-5-8 Person-NG 2-Elig	$311.99 / 1 Day
Res Hab-5-8 Person-NG 2-Elig-w/Day Supports	$250.71 / 1 Day
Res Hab-5-8 Person-NG 3-Elig	$360.24 / 1 Day
Res Hab-5-8 Person-NG 3-Elig-w/Day Supports	$314.42 / 1 Day
Res Hab-5-8 Person-NG 4-Elig	$429.04 / 1 Day
Res Hab-5-8 Person-NG 4-Elig-w/Day Supports	$338.58 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.

County : York/Adams
\|Service Name / Level	\|Rate

CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.

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