1548369028 NPI number — CK-KC LTC, INC

Table of content: (NPI 1548369028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548369028 NPI number — CK-KC LTC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CK-KC LTC, 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:
HERSHEY LONG TERM CARE PHARMACY
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:
1548369028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 GRUBB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMYRA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17078-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-832-2050
Provider Business Mailing Address Fax Number:
717-832-2051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 GRUBB STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMYRA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-832-2050
Provider Business Practice Location Address Fax Number:
717-832-2051
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-832-2050

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PP415557L , 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: MA1865498 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com