1215326335 NPI number — ACTS SIGNATURE COMMUNITY SERVICES, INC.

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 1215326335 NPI number — ACTS SIGNATURE COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTS SIGNATURE COMMUNITY SERVICES, 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:
PRIMARY CARE SERVICES AT AZALEA TRACE
Provider Other Organization Name Type Code:
3
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:
1215326335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-787-4097
Provider Business Mailing Address Fax Number:
215-699-2065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10100 HILLVIEW DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-478-5200
Provider Business Practice Location Address Fax Number:
850-474-0558
Provider Enumeration Date:
01/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AHERN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
215-661-8330

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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