1730332230 NPI number — ICAN ABILITY SPECIALISTS, INC

Table of content: (NPI 1730332230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730332230 NPI number — ICAN ABILITY SPECIALISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ICAN ABILITY SPECIALISTS, 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:
1730332230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 S MADDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-7954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-620-8109
Provider Business Mailing Address Fax Number:
717-918-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5130 E TRINDLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-3685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-620-8109
Provider Business Practice Location Address Fax Number:
717-918-2020
Provider Enumeration Date:
10/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALASUNDRAM
Authorized Official First Name:
REUBEN
Authorized Official Middle Name:
SELVADAS
Authorized Official Title or Position:
PRESIDENT, TREASURER, SECRETARY
Authorized Official Telephone Number:
717-620-8109

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT020070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT018260 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225CA2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225CX0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OC008552 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XE0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XF0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X , with the licence number: 020070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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