1528408689 NPI number — PHOENIX REHABILITATION AND HEALTH SERVICES, INC.

Table of content: (NPI 1528408689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528408689 NPI number — PHOENIX REHABILITATION AND HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX REHABILITATION AND HEALTH SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1528408689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 INNOVATION DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIRSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15717-8096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-343-4060
Provider Business Mailing Address Fax Number:
724-343-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7447 ADMIRAL PEARY HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CRESSON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16630-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-886-9315
Provider Business Practice Location Address Fax Number:
814-886-9316
Provider Enumeration Date:
07/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GIANNETTA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT OF COMPLIANCE
Authorized Official Telephone Number:
724-343-4060

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101954133001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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