1760854293 NPI number — LCH HEALTH AND COMMUNITY SERVICES

Table of content: (NPI 1760854293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760854293 NPI number — LCH HEALTH AND COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCH HEALTH AND COMMUNITY SERVICES
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:
1760854293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 W CYPRESS 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:
19348-2419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-444-7550
Provider Business Mailing Address Fax Number:
610-444-4656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 N 3RD ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19363-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-444-7550
Provider Business Practice Location Address Fax Number:
610-444-4656
Provider Enumeration Date:
10/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GANNON
Authorized Official First Name:
RONAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-444-7550

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: 100752680-0008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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