1396250833 NPI number — COMMUNITY SERVICES OF DEVEREUX

Table of content: SARAH MICHELLE CHANG MD (NPI 1790280402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396250833 NPI number — COMMUNITY SERVICES OF DEVEREUX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SERVICES OF DEVEREUX
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:
1396250833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1041 W BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIXVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19460-4342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-422-1463
Provider Business Mailing Address Fax Number:
610-933-7451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 HENRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19129-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-864-6666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOPKINS
Authorized Official First Name:
DENISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT ANALYST
Authorized Official Telephone Number:
610-542-3042

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: 100001913 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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