1740713056 NPI number — ACCESS DIRECT SUPPORT COORDINATION INC.

Table of content: (NPI 1740713056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740713056 NPI number — ACCESS DIRECT SUPPORT COORDINATION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS DIRECT SUPPORT COORDINATION 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:
1740713056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
696 2ND STREET PIKE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
RICHBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18954-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-800-9800
Provider Business Mailing Address Fax Number:
215-645-5114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
696 2ND STREET PIKE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
RICHBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18954-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-800-9800
Provider Business Practice Location Address Fax Number:
215-645-5114
Provider Enumeration Date:
04/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LUSHCHYK
Authorized Official First Name:
ALLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-512-9400

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1031084950002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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