1285697706 NPI number — DCA OF CARLISLE INC

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 1285697706 NPI number — DCA OF CARLISLE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DCA OF CARLISLE 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:
1285697706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72403-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-931-5400
Provider Business Mailing Address Fax Number:
870-931-5418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NOBLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-258-3099
Provider Business Practice Location Address Fax Number:
717-258-3632
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT & SECRETARY
Authorized Official Telephone Number:
214-213-4700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016627710001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1520690 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "AUSA LIFE INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "COMBINED INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "CAREFIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "FRANK J SIRACUSA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "CORNING HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "FLEET RESERVE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "AARP/UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "CARPENTERS HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "AMERICAN MARITIME" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "BOARD OF PENSIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5694652 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1662771 . This is a "HEALTHMATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 392627 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PPA01553 . This is a "PA CHRONIC RENAL PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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