1487124723 NPI number — MARK A BORLAND

Table of content: (NPI 1487124723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487124723 NPI number — MARK A BORLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A BORLAND
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:
MILLCREEK COUNSELING ASSOCIATES
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:
1487124723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6911 WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRVIEW
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16415-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-722-7467
Provider Business Mailing Address Fax Number:
814-836-8194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1738 W 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16505-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-722-7467
Provider Business Practice Location Address Fax Number:
814-836-8194
Provider Enumeration Date:
11/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BORLAND
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-722-7467

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1029517440001 . This is a "PROMISE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1295145795 . This is a "NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12686599 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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