1598838328 NPI number — PRO CARE HEALTH SYSTEMS INC

Table of content: (NPI 1598838328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598838328 NPI number — PRO CARE HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO CARE HEALTH SYSTEMS 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:
PRO CARE HEALTH SYSTEMS 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:
1598838328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E PLANK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16602-4154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-941-7708
Provider Business Mailing Address Fax Number:
814-941-7715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E. PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-941-7708
Provider Business Practice Location Address Fax Number:
814-941-7715
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAUGLE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
814-941-7708

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 361648 . This is a "HIGHMARK PT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 957015 . This is a "HIGHMARK OT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CH9813 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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