1205822418 NPI number — DUBOIS CONTINUUM OF CARE COMMUNITY, INC.

Table of content: (NPI 1205822418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205822418 NPI number — DUBOIS CONTINUUM OF CARE COMMUNITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBOIS CONTINUUM OF CARE COMMUNITY, INC.
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:
1205822418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 S 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-2811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-375-9100
Provider Business Mailing Address Fax Number:
814-375-3979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-9100
Provider Business Practice Location Address Fax Number:
814-375-3979
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NESBIT
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
814-375-9100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  560402 , 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: 0007463490002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com