1770034191 NPI number — R-HEALTH PRIMARY CARE MEDICAL HOME LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770034191 NPI number — R-HEALTH PRIMARY CARE MEDICAL HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R-HEALTH PRIMARY CARE MEDICAL HOME LLC
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:
1770034191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 YORKTOWN PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-600-4590
Provider Business Mailing Address Fax Number:
215-600-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 SCOTCH RD
Provider Second Line Business Practice Location Address:
UNIT B1
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08628-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-600-4590
Provider Business Practice Location Address Fax Number:
215-600-4599
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
AUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-600-4590

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD068622L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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