1780853994 NPI number — MERAKEY PENNSYLVANIA

Table of content: (NPI 1780853994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780853994 NPI number — MERAKEY PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERAKEY PENNSYLVANIA
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:
NORTHWESTERN HUMAN SERVICES OF PA
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:
1780853994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4391 STURBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-836-3131
Provider Business Mailing Address Fax Number:
215-273-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 N BOWER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17976-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-836-3131
Provider Business Practice Location Address Fax Number:
215-273-5975
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TILSON
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CORP SR. DIRECTOR OF BUSINESS OPS
Authorized Official Telephone Number:
215-836-3131

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000017440175 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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