1457419509 NPI number — HUMANGOOD PENNSYLVANIA

Table of content: (NPI 1457419509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457419509 NPI number — HUMANGOOD PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMANGOOD PENNSYLVANIA
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:
SPRING MILL PRESBYTERIAN VILLAGE
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:
1457419509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 JOSHUA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19444-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-260-1125
Provider Business Mailing Address Fax Number:
610-260-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 JOSHUA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19444-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-828-4848
Provider Business Practice Location Address Fax Number:
610-828-4864
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAPPEN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
610-260-1135

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  A93040 , 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: 284878 . This is a "OCCUPANCY PERMIT #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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