1881637551 NPI number — BEVERLY ENTERPRISES - PENNSYLVANIA, INC.

Table of content: (NPI 1881637551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881637551 NPI number — BEVERLY ENTERPRISES - PENNSYLVANIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEVERLY ENTERPRISES - PENNSYLVANIA, 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:
1881637551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
383 MOUNTAIN VIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-743-6613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
383 MOUNTAIN VIEW DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-743-6613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RASMUSSEN-JONES
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
479-201-4835

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1126689 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1505672 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 126206 . This is a "HEALTHAMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0644 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000077080 . This is a "TRHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 523594 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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