1386699346 NPI number — NORTHWEST TOTAL CARE CENTER ASSOCIATES, L.P.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386699346 NPI number — NORTHWEST TOTAL CARE CENTER ASSOCIATES, L.P.

Employer Identification Number (EIN):

Provider Organization Name:

NORTHWEST TOTAL CARE CENTER ASSOCIATES, L.P.

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1386699346

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/21/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

101 E STATE ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

KENNETT SQUARE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19348-3109

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-925-4436

Provider Business Mailing Address Fax Number:

610-925-4351

Provider First Line Business Practice Location Address:

290 RED SCHOOL LN

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PHILLIPSBURG

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08865-2276

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

908-859-2800

Provider Business Practice Location Address Fax Number:

908-859-4532

Provider Enumeration Date:

05/24/2006

Authorized Official Last Name:

DROPESKEY

Authorized Official First Name:

JANE

Authorized Official Middle Name:

Authorized Official Title or Position:

CORPORATE MANAGER

Authorized Official Telephone Number:

610-925-4231

• Taxonomy code: 310400000X , with the licence number:  953335 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 314000000X , with the licence number: 062106 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0004475000 . This is a "AMERIHEALTH-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0004475000 . This is a "IBC-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0004475000 . This is a "IBC-TRADITIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 000822 . This is a "HORIZON - SUB" identifier . This identifiers is of the category "OTHER".
• Identifier: 317107 . This is a "US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 0004475000 . This is a "AMERIHEALTH-TRADITIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 2049077 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 315316 . This is a "HORIZION - SNF" identifier . This identifiers is of the category "OTHER".
• Identifier: 5222702 . This is a "UNISYS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 21620 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".