1306174503 NPI number — SWISHER BEHAVIORAL HEALTH SERVICES, INC

Table of content: (NPI 1306174503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306174503 NPI number — SWISHER BEHAVIORAL HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWISHER BEHAVIORAL HEALTH 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:
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:
1306174503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5357 ACORN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HESSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16647-8353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-644-8766
Provider Business Mailing Address Fax Number:
814-658-3551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-644-8766
Provider Business Practice Location Address Fax Number:
814-658-3551
Provider Enumeration Date:
11/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SWISHER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
814-644-8766

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS 007785-L , 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: 1017965620001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018572650001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016140950005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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