1346665635 NPI number — EBH NORTHEAST SERVICES, INC.

Table of content: (NPI 1346665635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346665635 NPI number — EBH NORTHEAST SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBH NORTHEAST 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:
COTTAGES @ CLARITY WAY
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:
1346665635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
377 RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37064-8964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-567-7250
Provider Business Mailing Address Fax Number:
615-807-2931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
544 IRON RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-6838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-225-3906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GANUES
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR REVENUE CYCLE
Authorized Official Telephone Number:
615-567-7255

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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