1235134446 NPI number — CARBON COUNTY

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 1235134446 NPI number — CARBON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARBON COUNTY
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:
1235134446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERLY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18255-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-427-8683
Provider Business Mailing Address Fax Number:
570-427-4988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 EVERGREEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERLY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18255-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-427-8683
Provider Business Practice Location Address Fax Number:
570-427-4988
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEKISZ
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSING HOME ADMINISTRATOR
Authorized Official Telephone Number:
570-427-8683

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  030602 , 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: CA3326 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 037720600 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007600550014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HO634394 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".




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