1154547586 NPI number — COMMUNITY GUIDANCE CENTER

Table of content: (NPI 1154547586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154547586 NPI number — COMMUNITY GUIDANCE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY GUIDANCE CENTER
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:
1154547586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
793 OLD ROUTE 119 HWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-1372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-5576
Provider Business Mailing Address Fax Number:
724-463-3262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 CENTRAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSSITER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-465-5576
Provider Business Practice Location Address Fax Number:
724-463-3262
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORSHA
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
724-465-5576

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  421220 , 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: 1000033280026 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com