1386124931 NPI number — SLATE BELT HOME CARE, LLC

Table of content: (NPI 1386124931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386124931 NPI number — SLATE BELT HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLATE BELT HOME CARE, LLC
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:
1386124931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT BETHEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-897-7900
Provider Business Mailing Address Fax Number:
570-897-7901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1597 S. DELAWARE DRIVE, SUITE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT BETHEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-7900
Provider Business Practice Location Address Fax Number:
570-897-7901
Provider Enumeration Date:
08/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FLAIM
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
570-897-7900

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  19583601 , 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: 001715098-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com