1881970226 NPI number — CHESTNUTKNOLL AT HOME

Table of content: (NPI 1881970226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881970226 NPI number — CHESTNUTKNOLL AT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTNUTKNOLL AT HOME
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:
1881970226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1041 E. PHILADELPHIA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 E PHILADELPHIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19525-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-473-7291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
DANEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECIALIST
Authorized Official Telephone Number:
610-473-7291

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  13263601 , 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)

  • Identifier: 1009438050001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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