1073572871 NPI number — PERINI SERVICES/SOUTHAMPTON MANOR LP

Table of content: (NPI 1073572871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073572871 NPI number — PERINI SERVICES/SOUTHAMPTON MANOR LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERINI SERVICES/SOUTHAMPTON MANOR LP
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:
1073572871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 UNDERPASS WAY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740-6979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-745-8700
Provider Business Mailing Address Fax Number:
301-790-3094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 WALNUT BOTTOM ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPPENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17257-9005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-530-8300
Provider Business Practice Location Address Fax Number:
717-530-8304
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERINI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-745-8700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  035002 , 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: 0015509080002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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