1336289446 NPI number — LIFE BEAVER COUNTY

Table of content: (NPI 1336289446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336289446 NPI number — LIFE BEAVER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE BEAVER COUNTY
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:
LIFE BEAVER
Provider Other Organization Name Type Code:
5
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:
1336289446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 FREEDOM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBERRY TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-776-1100
Provider Business Mailing Address Fax Number:
724-776-0811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 PLEASANT DR
Provider Second Line Business Practice Location Address:
CENTERPLACE SUITE 1
Provider Business Practice Location Address City Name:
ALIQUIPPA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15001-1384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-378-5400
Provider Business Practice Location Address Fax Number:
724-302-2093
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIGIROLAMO
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
C. F. O.
Authorized Official Telephone Number:
724-776-1100

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  043820 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311ZA0620X , with the licence number: 043820 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0019765400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com