1639183817 NPI number — HCF OF EDINBORO, 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 1639183817 NPI number — HCF OF EDINBORO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HCF OF EDINBORO, 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:
EDINBORO MANOR
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:
1639183817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 WATERFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16412-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-734-5021
Provider Business Mailing Address Fax Number:
814-734-1433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 WATERFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16412-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-734-5021
Provider Business Practice Location Address Fax Number:
814-734-1433
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STECHSCHULTE
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR - CORPORATE COMPLIANCE
Authorized Official Telephone Number:
419-999-2010

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  053002 , 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: 0019250770001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0987 . This is a "SECURITY BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000099845 . This is a "THREE RIVERS/UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 305044 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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