1669477261 NPI number — MORNINGSTAR SENIOR LIVING INC

Table of content: (NPI 1669477261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669477261 NPI number — MORNINGSTAR SENIOR LIVING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORNINGSTAR SENIOR LIVING 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:
MORAVIAN HALL SQUARE HEALTH AND WELLNESS CENTER
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:
1669477261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 W NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAZARETH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18064-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-746-1000
Provider Business Mailing Address Fax Number:
610-746-1444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 W NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAZARETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18064-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-746-1000
Provider Business Practice Location Address Fax Number:
610-746-1444
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
SENIOR DIRECTOR & CONTROLLER
Authorized Official Telephone Number:
610-746-1007

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  226280 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 392702 , 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)

  • Identifier: 1007561970002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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