1194989376 NPI number — MARTHA LLOYD CRF SYLVANIA HOUSE

Table of content: (NPI 1194989376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194989376 NPI number — MARTHA LLOYD CRF SYLVANIA HOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA LLOYD CRF SYLVANIA HOUSE
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:
1194989376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16947-1131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-297-2185
Provider Business Mailing Address Fax Number:
570-297-1019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2187 SYLVANIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16947-9619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-297-2185
Provider Business Practice Location Address Fax Number:
570-297-1019
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CRF DIRECTOR
Authorized Official Telephone Number:
570-297-2185

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1015544810010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com