1609968114 NPI number — KEYSTONE RURAL HEALTH CONSORTIA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609968114 NPI number — KEYSTONE RURAL HEALTH CONSORTIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE RURAL HEALTH CONSORTIA, 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:
1609968114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 E 2ND ST
Provider Second Line Business Mailing Address:
P.O. BOX 270
Provider Business Mailing Address City Name:
EMPORIUM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15834-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-486-1115
Provider Business Mailing Address Fax Number:
814-486-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIUM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15834-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-486-1115
Provider Business Practice Location Address Fax Number:
814-486-0404
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENNARDI
Authorized Official First Name:
KRISTIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
814-486-1115

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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