1538589718 NPI number — STAFFING VILLAGE INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538589718 NPI number — STAFFING VILLAGE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAFFING VILLAGE 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:
STAFFING VILLAGE HOME HEALTH CARE
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:
1538589718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 GLEN AVON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-889-9792
Provider Business Mailing Address Fax Number:
484-494-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 GLEN AVON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-540-7697
Provider Business Practice Location Address Fax Number:
484-494-7385
Provider Enumeration Date:
04/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOLLIE-JONES
Authorized Official First Name:
TRINIDA
Authorized Official Middle Name:
LOVE
Authorized Official Title or Position:
CEO/ADMINISTRATOR/DIRECTOR
Authorized Official Telephone Number:
484-888-1622

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  05300501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 05300501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 05300501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 05300501 , 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)





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