1780687913 NPI number — COMMUNITY NURSING SERVICES OF NORTH EAST

Table of content: (NPI 1780687913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780687913 NPI number — COMMUNITY NURSING SERVICES OF NORTH EAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY NURSING SERVICES OF NORTH EAST
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:
HOSPICE OF COMMUNITY NURSING SERVICES OF NORTH EAST
Provider Other Organization Name Type Code:
5
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:
1780687913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PARK ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH EAST
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-725-4300
Provider Business Mailing Address Fax Number:
814-725-4664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-725-4300
Provider Business Practice Location Address Fax Number:
814-725-4664
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KECER-BROWN
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
814-725-4300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  708905 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: 16451601 , 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)

  • Identifier: 1842 . This is a "BLUE CROSS HOSPICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010636400005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0740 . This is a "BLUE CROSS HOME HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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