1235100751 NPI number — HOMEMAKERS OF WESTERN PENNA, INC.

Table of content: (NPI 1235100751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235100751 NPI number — HOMEMAKERS OF WESTERN PENNA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEMAKERS OF WESTERN PENNA, 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:
1235100751
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:
2465 SHERIDAN DR
Provider Second Line Business Mailing Address:
C/O HOMEMAKERS UPSTATE GROUP, INC.
Provider Business Mailing Address City Name:
TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14150-9407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-838-6060
Provider Business Mailing Address Fax Number:
716-838-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2820 W 23RD ST
Provider Second Line Business Practice Location Address:
SUITE #8 EBCO PARK
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16506-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-838-8696
Provider Business Practice Location Address Fax Number:
814-835-2003
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLITT
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP&CFO
Authorized Official Telephone Number:
716-838-6060

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  003105 , 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: 100732829003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1244 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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