1487748570 NPI number — P.R.N. HOME HEALTH AGENCY LP

Table of content: (NPI 1487748570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487748570 NPI number — P.R.N. HOME HEALTH AGENCY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P.R.N. HOME HEALTH AGENCY LP
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:
AMBASSADOR NURSING CARE LP
Provider Other Organization Name Type Code:
4
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:
1487748570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
573 BRADDOCK AVENUE
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
EAST PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-860-8222
Provider Business Mailing Address Fax Number:
412-824-6390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
573 BRADDOCK AVENUE
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
EAST PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-211-6002
Provider Business Practice Location Address Fax Number:
412-824-6390
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUFFY
Authorized Official First Name:
GINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
800-860-8222

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  767405 , 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: 1018536040001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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