1306392105 NPI number — B-K HEALTH CENTER, INC

Table of content: (NPI 1306392105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306392105 NPI number — B-K HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B-K HEALTH CENTER, 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:
NEPA COMMUNITY HEALTH CARE
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:
1306392105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
498 S MAIN ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18801-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-278-7500
Provider Business Mailing Address Fax Number:
570-278-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2380 ELK LAKE SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18844-7710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-1106
Provider Business Practice Location Address Fax Number:
570-278-0707
Provider Enumeration Date:
08/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FOLLERT
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-278-5157

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007701310046 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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