1295994341 NPI number — COMMUNITY HEALTH AND DENTAL CARE, INC

Table of content: (NPI 1295994341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295994341 NPI number — COMMUNITY HEALTH AND DENTAL CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH AND DENTAL CARE, 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:
POTTSTOWN AREA HEALTH CENTER, INC
Provider Other Organization Name Type Code:
4
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:
1295994341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 W SCHUYLKILL RD STE G-15A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19465-7438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-326-9460
Provider Business Mailing Address Fax Number:
484-941-5080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 W SCHUYLKILL RD STE G-15A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19465-7438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-326-9460
Provider Business Practice Location Address Fax Number:
610-222-5006
Provider Enumeration Date:
06/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCGIVERN
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
610-326-9460

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  3293340 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 3293340 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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