1871535153 NPI number — MERIDIAN HEALTH, INC

Table of content: (NPI 1871535153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871535153 NPI number — MERIDIAN HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN HEALTH, 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:
LONG GREEN 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:
1871535153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E MELROSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-435-9073
Provider Business Practice Location Address Fax Number:
410-435-6824
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DROPESKEY
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE MANAGER
Authorized Official Telephone Number:
610-925-4231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  30-044 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 302477600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71-00099 . This is a "UNITED - EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08950 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240547 . This is a "UNITED - MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: MJ4 . This is a "CAREFIRST - IND/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0181371 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02B1 . This is a "CAREFIRST PROV/INQ #" identifier . This identifiers is of the category "OTHER".
  • Identifier: MJ4 . This is a "CAREFIRST BLUECHOICE" identifier . This identifiers is of the category "OTHER".




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