1629050620 NPI number — WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY LLC

Table of content: (NPI 1629050620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629050620 NPI number — WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY LLC
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:
GENERAL COMMUNITY PHARMACY
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:
1629050620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
562 WYOMING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-552-7500
Provider Business Mailing Address Fax Number:
570-552-7520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
562 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-552-7500
Provider Business Practice Location Address Fax Number:
570-552-7520
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/DELEGATED OFFICIAL
Authorized Official Telephone Number:
629-215-3953

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X , with the licence number: PP413699L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1022885770017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085164 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com