1538341334 NPI number — CAREGIVERS OF SOUTHWESTERN PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538341334 NPI number — CAREGIVERS OF SOUTHWESTERN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREGIVERS OF SOUTHWESTERN PA
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:
1538341334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 HARTMAN RD
Provider Second Line Business Mailing Address:
OAKLEY PARK II SUITE 207-ROUTE 30 EAST
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-7220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-834-5774
Provider Business Mailing Address Fax Number:
724-834-5399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 HARTMAN RD
Provider Second Line Business Practice Location Address:
OAKLEY PARK II SUITE 207-ROUTE 30 EAST
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-5774
Provider Business Practice Location Address Fax Number:
724-834-5399
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRIMUS
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
724-834-5774

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  401310 , 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: 401310 . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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