1265584833 NPI number — PENNSYLVANIA PACE, INC.

Table of content: (NPI 1265584833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265584833 NPI number — PENNSYLVANIA PACE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA PACE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SENIOR LIFE JOHNSTOWN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265584833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 SIGMA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15238-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-963-9150
Provider Business Mailing Address Fax Number:
412-963-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15906-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-535-6000
Provider Business Practice Location Address Fax Number:
814-248-7902
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENNELL
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
412-963-9150

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X , with the licence number: 9963601 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 104070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101362553-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: H3925 . This is a "MEDICARE AGREEMENT NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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