1548239536 NPI number — YORK HEALTH BOUTIQUE FOR WOMEN

Table of content: (NPI 1548239536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548239536 NPI number — YORK HEALTH BOUTIQUE FOR WOMEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YORK HEALTH BOUTIQUE FOR WOMEN
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:
1548239536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 LEADERS HEIGHTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-4742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-741-0127
Provider Business Mailing Address Fax Number:
717-741-0168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 LEADERS HEIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-741-0127
Provider Business Practice Location Address Fax Number:
717-741-0168
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAVETAN
Authorized Official First Name:
URITH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRES. (OWNER)
Authorized Official Telephone Number:
717-741-0127

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  6000005630 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 211107 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39HA96 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 123905 . This is a "UNISON/THREE RIVERS/MEDPL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018221500002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20022585 . This is a "AMERI HEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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