1881014785 NPI number — CLEAN AND SOBER HUMANS ASSOC., INC.

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 1881014785 NPI number — CLEAN AND SOBER HUMANS ASSOC., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAN AND SOBER HUMANS ASSOC., 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:
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:
1881014785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
827 BROADWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC KEES ROCKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15136-2227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-875-0020
Provider Business Mailing Address Fax Number:
412-331-3718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
827 BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KEES ROCKS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15136-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-875-0020
Provider Business Practice Location Address Fax Number:
412-331-3718
Provider Enumeration Date:
04/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DICENZO
Authorized Official First Name:
PANFILO
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
412-875-0020

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)





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