1730120486 NPI number — GMA-MADISON INC

Table of content: (NPI 1730120486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730120486 NPI number — GMA-MADISON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GMA-MADISON 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:
MADISON REHABILITATION AND NURSING CENTER
Provider Other Organization Name Type Code:
3
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:
1730120486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 BAKERS RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26508-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-285-0692
Provider Business Practice Location Address Fax Number:
304-285-0693
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DROPESKEY
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE MANAGER
Authorized Official Telephone Number:
610-925-4231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  131 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2507253 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003608000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: NZ5 . This is a "CAREFIRST BLUECHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000324442 . This is a "MOUNTAIN STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02EF . This is a "CAREFIRST - PROV/INQ#" identifier . This identifiers is of the category "OTHER".
  • Identifier: NZ5 . This is a "CAREFIRST IND/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 282334 . This is a "UNITED - MAMSI" identifier . This identifiers is of the category "OTHER".




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