1104949320 NPI number — CRIME VICTIM CENTER OF ERIE COUNTY, INC.

Table of content: TAMARA LEE FOSTER DT (NPI 1477799062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104949320 NPI number — CRIME VICTIM CENTER OF ERIE COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRIME VICTIM CENTER OF ERIE COUNTY, 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:
ERIE COUNTY RAPE CRISIS CENTER, INC.
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:
1104949320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16501-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-455-9414
Provider Business Mailing Address Fax Number:
814-455-9300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16501-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-455-9414
Provider Business Practice Location Address Fax Number:
814-455-9300
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POROWSKI
Authorized Official First Name:
SUSANNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
814-455-9414

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)





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