1710084918 NPI number — AMERICAN HOMECARE SUPPLY MID ATLANTIC LLC

Table of content: (NPI 1710084918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710084918 NPI number — AMERICAN HOMECARE SUPPLY MID ATLANTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HOMECARE SUPPLY MID ATLANTIC LLC
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:
YOUNG'S MEDICAL EQUIPMENT
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:
1710084918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2710 EMRICK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18020-8012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-882-8880
Provider Business Mailing Address Fax Number:
610-867-7023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 LEADERS HEIGHTS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-699-5511
Provider Business Practice Location Address Fax Number:
717-741-4752
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROCCO
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
800-631-3031

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007735180028 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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