1558368589 NPI number — BROTHERSTON HOMECARE, INC.

Table of content: (NPI 1558368589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558368589 NPI number — BROTHERSTON HOMECARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROTHERSTON HOMECARE, 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:
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:
1558368589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1412 WELLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSALEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19020-4468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-633-7300
Provider Business Mailing Address Fax Number:
215-633-7304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 WELLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-4468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-633-7300
Provider Business Practice Location Address Fax Number:
215-633-7304
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FEENEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-633-7300

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  6000003436 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 6000003436 , 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: 0012078200002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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