1336203017 NPI number — FAMILY FIRST HEALTH CORPORATION

Table of content: (NPI 1336203017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336203017 NPI number — FAMILY FIRST HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTH 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:
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:
1336203017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 S GEORGE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17401-1474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-846-5846
Provider Business Mailing Address Fax Number:
717-854-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-632-9052
Provider Business Practice Location Address Fax Number:
855-332-9945
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLERTH
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER/PRESIDENT
Authorized Official Telephone Number:
717-801-4804

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 1145775 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007548530020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1519236 . This is a "HIGHMARK WHOLECARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: BL65 . This is a "CAREFIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 582J . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50047911 . This is a "CBC-KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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