1154600500 NPI number — FOULKEWAYS AT GWYNEDD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154600500 NPI number — FOULKEWAYS AT GWYNEDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOULKEWAYS AT GWYNEDD
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:
6
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:
1154600500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 MEETINGHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GWYNEDD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19436-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-643-2200
Provider Business Mailing Address Fax Number:
215-591-2286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 MEETINGHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GWYNEDD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19436-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-643-2200
Provider Business Practice Location Address Fax Number:
215-591-2286
Provider Enumeration Date:
08/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRISTINZIO
Authorized Official First Name:
EDNA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
215-283-7002

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5862 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002612 . This is a "HIGHMARK MEDICARE SERVICE" identifier . This identifiers is of the category "OTHER".




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