1245238724 NPI number — PHOEBE RICHLAND HEALTH CARE CENTER

Table of content: (NPI 1245238724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245238724 NPI number — PHOEBE RICHLAND HEALTH CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOEBE RICHLAND HEALTH CARE CENTER
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:
1245238724
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:
1925 W TURNER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-794-5010
Provider Business Mailing Address Fax Number:
610-794-5400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLANDTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18955-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-371-4525
Provider Business Practice Location Address Fax Number:
267-371-4670
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
610-794-5142

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  260302 , 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: 2533957 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6275 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018166900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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