1013990704 NPI number — MERCY TYLER HOME HEALTH SERVICES

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 1013990704 NPI number — MERCY TYLER HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY TYLER HOME HEALTH SERVICES
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:
1013990704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 SR 6 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUNKHANNOCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18657-6149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-836-1640
Provider Business Mailing Address Fax Number:
570-836-6415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 SR 6 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-6149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-1640
Provider Business Practice Location Address Fax Number:
570-836-6415
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKO
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
570-348-7074

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  757005 , 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: 5260031 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1526558 . This is a "GATEWAY HLTH PLN PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397570 . This is a "BC ACCESS CARE II PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397570 . This is a "BLUE CROSS OF NEPA PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080381 . This is a "FIRST PRIORITY HLTH PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 117925 . This is a "THREE RIVERS HLTH PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014335270002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30868 . This is a "GEISINGER HLTH PLN PRVDR#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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