1417940487 NPI number — INTERIM HEALTHCARE OF WESTERN PENNSYLVANIA INC

Table of content: (NPI 1417940487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940487 NPI number — INTERIM HEALTHCARE OF WESTERN PENNSYLVANIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF WESTERN PENNSYLVANIA 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:
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:
1417940487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 N BRADY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DU BOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-2227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-375-9615
Provider Business Mailing Address Fax Number:
814-375-1362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 N BRADY ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-9615
Provider Business Practice Location Address Fax Number:
814-375-1362
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEINDL
Authorized Official First Name:
ALISHA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/MANAGER
Authorized Official Telephone Number:
814-375-9615

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10000084500008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008518 . This is a "CLEAR-JEFF MHMR (HS)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1065 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 008509 . This is a "CLEAR-JEFF MHMR (EI)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000008450005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000008450013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1511022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000008450010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61-34 . This is a "VENANGO COUNTY MH/MR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000008450012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105044 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008501 . This is a "CLEAR-JEFF MHMR (HS)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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