1013135284 NPI number — WOMEN TO WOMEN

Table of content: (NPI 1013135284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013135284 NPI number — WOMEN TO WOMEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN TO WOMEN
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:
1013135284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 3RD AVE
Provider Second Line Business Mailing Address:
PARK OFFICE BUILDING 208 209
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-5816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-714-5800
Provider Business Mailing Address Fax Number:
570-714-0473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 3RD AVE
Provider Second Line Business Practice Location Address:
PARK OFFICE BUILDING 208 209
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-5800
Provider Business Practice Location Address Fax Number:
570-714-0473
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-714-5880

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  TP000953B , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007767610002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007767610007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007767610004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007767610008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100776761 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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