1528397015 NPI number — NEALEN PERSONAL CARE, INC.

Table of content: (NPI 1528397015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528397015 NPI number — NEALEN PERSONAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEALEN PERSONAL CARE, 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:
1528397015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1944 WILLIAM PENN AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15909-1637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-322-3401
Provider Business Mailing Address Fax Number:
814-322-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1944 WILLIAM PENN AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15909-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-322-3401
Provider Business Practice Location Address Fax Number:
814-322-3911
Provider Enumeration Date:
12/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GROVE
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-322-3401

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 101799340 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 101799340 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101799340 0003 . This is a "DPW/ MA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101799340 0006 . This is a "DPW/MA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101799340 0001 . This is a "DPW/ MA NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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