1841290731 NPI number — COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES

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 1841290731 NPI number — COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES
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:
6
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:
1841290731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 CHERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-533-0723
Provider Business Mailing Address Fax Number:
717-533-1014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3590 WASHINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-257-2474
Provider Business Practice Location Address Fax Number:
412-257-0358
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MIZAK
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VP- FINANCE, ACCOUNTING, INFO SRVS
Authorized Official Telephone Number:
717-533-0723

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  125402 , 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: 0009828380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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