1679023543 NPI number — HOMECARE OF PENNSYLVANIA

Table of content: (NPI 1679023543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679023543 NPI number — HOMECARE OF PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE OF PENNSYLVANIA
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:
1679023543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
239 MAIN ST STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKSON CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18519-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-780-8276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 MAIN ST STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18519-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-780-8276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHOENER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-780-8276

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA126303 . This is a "HOME IMPROVEMENT CONTRACTOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com