1033111208 NPI number — ALLEGHENY HEALTH NETWORK HOME INFUSION LLC

Table of content: (NPI 1033111208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033111208 NPI number — ALLEGHENY HEALTH NETWORK HOME INFUSION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGHENY HEALTH NETWORK HOME INFUSION LLC
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:
VANTAGE HME LIMITED
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:
1033111208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 S 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:
16335-3036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-693-2286
Provider Business Mailing Address Fax Number:
888-704-4877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 S 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:
16335-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-693-2286
Provider Business Practice Location Address Fax Number:
888-704-4877
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-337-0000

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  PP413955L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: PP413955L83105 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3968647 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007613480002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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