1114925492 NPI number — THE MEADOWOOD CORPORATION

Table of content: (NPI 1114925492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114925492 NPI number — THE MEADOWOOD CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEADOWOOD CORPORATION
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:
1114925492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 SKIPPACK PIKE
Provider Second Line Business Mailing Address:
PO BOX 670
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19490-0670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-584-1000
Provider Business Mailing Address Fax Number:
610-584-3645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 SKIPPACK PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19490-0670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-584-1000
Provider Business Practice Location Address Fax Number:
610-584-3645
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NORDEMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
610-584-3607

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  771105 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 175080 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 392602 , 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: 605498 . This is a "AETNA SNF PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1244 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 71-01050 . This is a "EVERCARE PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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