1265500185 NPI number — PENN FOUNDATION 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 1265500185 NPI number — PENN FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN FOUNDATION 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:
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:
1265500185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 LAWN AVENUE
Provider Second Line Business Mailing Address:
PO BOX 32
Provider Business Mailing Address City Name:
SELLERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-257-6551
Provider Business Mailing Address Fax Number:
215-257-9347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNNYBROOK VILLAGE
Provider Second Line Business Practice Location Address:
500 CREEKSIDE DRIVE
Provider Business Practice Location Address City Name:
SUITE 507
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-819-6000
Provider Business Practice Location Address Fax Number:
610-819-6004
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUGRAUER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
215-257-6551

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 129323 . This is a "HEALTH CHOICES" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PE113171 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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