1326447459 NPI number — HASLAM PROPERTIES

Table of content: (NPI 1326447459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326447459 NPI number — HASLAM PROPERTIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HASLAM PROPERTIES
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:
HOMEWELL OF SOUTHEASTERN PENNSYLVANIA
Provider Other Organization Name Type Code:
3
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:
1326447459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 FREEDOM BUSINESS CTR DR
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-938-7375
Provider Business Mailing Address Fax Number:
610-768-7755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 FREEDOM BUSINESS CTR DR
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-938-7375
Provider Business Practice Location Address Fax Number:
610-768-7755
Provider Enumeration Date:
08/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HASLAM
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
484-938-7375

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  23093601 , 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: 1027597880001 . This is a "MA (MEDICAL ASSISTANCE PROGRAM)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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