1518506930 NPI number — THE BRETHREN HOME COMMUNITY

Table of content: (NPI 1518506930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518506930 NPI number — THE BRETHREN HOME COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BRETHREN HOME COMMUNITY
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:
1518506930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2990 CARLISLE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW OXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-624-5500
Provider Business Mailing Address Fax Number:
717-624-5325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2990 CARLISLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW OXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-624-5500
Provider Business Practice Location Address Fax Number:
717-624-5325
Provider Enumeration Date:
01/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOWERS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
717-624-5498

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007487610005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".