1164633285 NPI number — SUSANS VICTORIAN COTTAGE

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 1164633285 NPI number — SUSANS VICTORIAN COTTAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSANS VICTORIAN COTTAGE
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:
VICTORIAN COTTAGE PERSONAL CARE HOME
Provider Other Organization Name Type Code:
5
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:
1164633285
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:
RR 5 BOX 64E (OLD ADDRESS BEFORE IT CHANGED)
Provider Second Line Business Mailing Address:
111 HYDRANGEA LANE (NEW 911 EMS ADDRESS)
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15666-3648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-424-8706
Provider Business Mailing Address Fax Number:
724-423-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 HYDRANGEA LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-424-8706
Provider Business Practice Location Address Fax Number:
724-423-6238
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
724-423-8706

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  001030 , 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)





Copyright © 2007-2024 www.npivalidator.com