1609011378 NPI number — CROZER-KEYSTONE COMMUNITY FOUNDATION

Table of content: (NPI 1609011378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609011378 NPI number — CROZER-KEYSTONE COMMUNITY FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROZER-KEYSTONE COMMUNITY FOUNDATION
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:
CROZER-KEYSTONE NURSE-FAMILY PARTNERSHIP
Provider Other Organization Name Type Code:
5
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:
1609011378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E STATE ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-3434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-744-1010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2602 W 9TH ST
Provider Second Line Business Practice Location Address:
COMMUNITY HOSPITAL MOB 2ND FLOOR
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-497-7344
Provider Business Practice Location Address Fax Number:
610-497-7472
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIG
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
610-497-7344

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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