1922530872 NPI number — WATSON & FINK ENTERPRISES LLC

Table of content: (NPI 1922530872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922530872 NPI number — WATSON & FINK ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATSON & FINK ENTERPRISES 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:
COMFORT KEEPERS
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:
1922530872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4508 MILLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16509-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-746-3939
Provider Business Mailing Address Fax Number:
814-746-3917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4508 MILLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-746-3939
Provider Business Practice Location Address Fax Number:
814-746-3917
Provider Enumeration Date:
03/30/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FINK
Authorized Official First Name:
JASON
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
440-813-5856

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  31753601 , 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)