1255488904 NPI number — COLUMBIA MONTOUR HOME HEALTH SERVICES VNA, INC.

Table of content: (NPI 1255488904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255488904 NPI number — COLUMBIA MONTOUR HOME HEALTH SERVICES VNA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA MONTOUR HOME HEALTH SERVICES VNA, 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:
Provider Other Organization Name Type Code:
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:
1255488904
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:
410 GLENN AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BLOOMSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17815-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-784-1723
Provider Business Mailing Address Fax Number:
570-784-8512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 S MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-759-3970
Provider Business Practice Location Address Fax Number:
570-759-7841
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GITTLER
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-784-1723

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  708605 , 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)

  • Identifier: 1007466820006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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