1588761845 NPI number — PENNSYLVANIA DEPARTMENT OF MILITARY AND VETERANS' AFFAIRS

Table of content: (NPI 1588761845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588761845 NPI number — PENNSYLVANIA DEPARTMENT OF MILITARY AND VETERANS' AFFAIRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA DEPARTMENT OF MILITARY AND VETERANS' AFFAIRS
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:
PENNSYLVANIA SOLDIERS' AND SAILORS' HOME
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:
1588761845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16512-6239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-871-4531
Provider Business Mailing Address Fax Number:
814-871-4617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16507-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-871-4531
Provider Business Practice Location Address Fax Number:
814-871-4617
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL SERVICES ADMINISTRATOR
Authorized Official Telephone Number:
814-242-7789

Provider Taxonomy Codes

  • Taxonomy code: 2865M2000X , with the licence number:  198202 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 448290 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com