1912983974 NPI number — TOWER HEALTH AT HOME - POTTSTOWN

Table of content: (NPI 1912983974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912983974 NPI number — TOWER HEALTH AT HOME - POTTSTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWER HEALTH AT HOME - POTTSTOWN
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:
1912983974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1170 BERKSHIRE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-378-0481
Provider Business Mailing Address Fax Number:
610-378-9762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1963 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-327-5700
Provider Business Practice Location Address Fax Number:
610-327-5701
Provider Enumeration Date:
12/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DECUSATIS
Authorized Official First Name:
LYNANN
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
610-378-0481

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  700805 , 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: 20007969 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000828000 . This is a "IBC BABY BLUE PRINT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00709363-01 . This is a "AMERCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 144363 . This is a "MEDPLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31756 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1141 . This is a "GENTIVA CARE CENTRIX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1683 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21740 . This is a "SENIOR PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21740 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007496750003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002893000 . This is a "IBC MOTHER OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007568000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1022268 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 231232574 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".