1265492185 NPI number — JBDL CORPORATION

Table of content: (NPI 1265492185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265492185 NPI number — JBDL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JBDL CORPORATION
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:
BECKETT APOTHECARY AND HOME HEALTH CARE
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:
1265492185
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:
1004 CHESTER PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19079-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 CHESTER PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19079-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-586-3100
Provider Business Practice Location Address Fax Number:
610-586-3700
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARAMANICO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY MGR
Authorized Official Telephone Number:
610-586-3100

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP410137L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 3903398 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000577774001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com