1194075796 NPI number — GENCARE,LLC

Table of content: DR. JULIANA JAMIRA GHEORGHIU RPH (NPI 1003937533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194075796 NPI number — GENCARE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENCARE,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:
1194075796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-479-3991
Provider Business Mailing Address Fax Number:
866-446-8819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 ABBOTT DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-479-3991
Provider Business Practice Location Address Fax Number:
866-446-8819
Provider Enumeration Date:
09/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
CHRISTYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-955-7421

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  39D0986041 , 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: 1018507830001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".