1245696434 NPI number — 123 PEDIATRIC HOME HEALTHCARE CORPORATION

Table of content: (NPI 1245696434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245696434 NPI number — 123 PEDIATRIC HOME HEALTHCARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
123 PEDIATRIC HOME HEALTHCARE CORPORATION
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:
1245696434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6309 HALLWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15147-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-377-9102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6309 HALLWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15147-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-377-9102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
JUANITA
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
412-377-9102

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW017087 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0200X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0218X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WX0200X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 06400501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 06400501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 06400501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: RN620599 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 30153601 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 06400501 , 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: 1030784200001 . This is a "STATE OF PA DHS OFFICE OF INTELLECTUAL DISABILITIES PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 06400501 . This is a "STATE OF PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30153601 . This is a "STATE OF PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030784200002 . This is a "STATE OF PA DHS OFFICE OF LONG TERM LIVING PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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