1013483411 NPI number — A-1 CARE COORDINATION LLC

Table of content: ROBERT PENN (NPI 1144828443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013483411 NPI number — A-1 CARE COORDINATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A-1 CARE COORDINATION 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:
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:
1013483411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 SOUTH 5TH STREET, DARBY PA 19023
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-462-9485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527B ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLCROFT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19032-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-462-9485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OMOJOKUN
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
OLUMUYIWA
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
678-462-9485

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 831417668 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com