1225403439 NPI number — FROM THE HEART LAUREL HIGHLANDS COMPANION SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225403439 NPI number — FROM THE HEART LAUREL HIGHLANDS COMPANION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FROM THE HEART LAUREL HIGHLANDS COMPANION SERVICES
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:
1225403439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 WOOD DUCK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-955-8986
Provider Business Mailing Address Fax Number:
724-590-5148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 WOOD DUCK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-955-8986
Provider Business Practice Location Address Fax Number:
724-590-5148
Provider Enumeration Date:
12/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DURICK
Authorized Official First Name:
JANIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-955-8986

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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