1275833006 NPI number — TOWER HEALTH AT HOME - POTTSTOWN

Table of content: (NPI 1275833006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275833006 NPI number — TOWER HEALTH AT HOME - POTTSTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWER HEALTH AT HOME - POTTSTOWN
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:
1275833006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1170 BERKSHIRE BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-378-0481
Provider Business Mailing Address Fax Number:
610-378-9762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1963 E. HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-327-5700
Provider Business Practice Location Address Fax Number:
610-327-5701
Provider Enumeration Date:
10/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DECUSATIS
Authorized Official First Name:
LYNANN
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
610-378-0481

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLIA 39D0204552 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007496750003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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