1720142490 NPI number — FAMILY FIRST HEALTH CORPORATION

Table of content: (NPI 1720142490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720142490 NPI number — FAMILY FIRST HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTH CORPORATION
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:
6
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:
1720142490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 S GEORGE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17401-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-846-5846
Provider Business Mailing Address Fax Number:
717-854-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 E BOUNDARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-843-5174
Provider Business Practice Location Address Fax Number:
855-732-3409
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLERTH
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER/PRESIDENT
Authorized Official Telephone Number:
707-801-4804

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007548530004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1145770 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0069099003 . This is a "AMERIHEALTH 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50047910 . This is a "CBC-KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com