1659706166 NPI number — THE SALVATION ARMY

Table of content: (NPI 1659706166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659706166 NPI number — THE SALVATION ARMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SALVATION ARMY
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:
THE SALVATION ARMY - DENTAL CENTER OF JOHNSTOWN
Provider Other Organization Name Type Code:
5
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:
1659706166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 W NYACK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10994-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-620-7200
Provider Business Mailing Address Fax Number:
845-620-7615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
647 MAIN STREET
Provider Second Line Business Practice Location Address:
PO BOX 968
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15907-0968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-539-3110
Provider Business Practice Location Address Fax Number:
814-536-4785
Provider Enumeration Date:
09/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SOUTHWICK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
845-620-7329

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS025867L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0011051320005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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