1861867921 NPI number — CARELINK COMMUNITY SUPPORT SERVICES

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 1861867921 NPI number — CARELINK COMMUNITY SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARELINK COMMUNITY SUPPORT 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:
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:
1861867921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
EDDYSTONE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19022-1375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-874-1119
Provider Business Mailing Address Fax Number:
610-872-3407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
338A HOLLIS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRUM LYNNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19022-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-833-5360
Provider Business Practice Location Address Fax Number:
610-833-1854
Provider Enumeration Date:
12/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WOOMER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-874-1119

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  195020 , 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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