1710973367 NPI number — VISITING NURSE ASSOCIATION OF CRAWFORD COUNTY, INC.

Table of content: (NPI 1710973367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710973367 NPI number — VISITING NURSE ASSOCIATION OF CRAWFORD COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISITING NURSE ASSOCIATION OF CRAWFORD COUNTY, 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:
1710973367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/01/2009
NPI Reactivation Date:
06/26/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16335-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-333-7000
Provider Business Mailing Address Fax Number:
814-333-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16335-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-333-7000
Provider Business Practice Location Address Fax Number:
814-333-7013
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
814-333-7000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  704105 , 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: 0722 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: V 0087 A . This is a "UPMCE & UPMC FOR YOU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 114303 . This is a "MEDPLUS/THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007287820001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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