1912096041 NPI number — THE BAIR FOUNDATION OF PENNSYLVANIA

Table of content: (NPI 1912096041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912096041 NPI number — THE BAIR FOUNDATION OF PENNSYLVANIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BAIR FOUNDATION OF PENNSYLVANIA
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:
1912096041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW WILMINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16142-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-946-8711
Provider Business Mailing Address Fax Number:
724-946-3249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 HOWARD AVENUE
Provider Second Line Business Practice Location Address:
EXECUTIVE HOUSE
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-941-5382
Provider Business Practice Location Address Fax Number:
814-940-1703
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESBENSHADE
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
724-946-8711

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  316390 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 432940 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X , with the licence number: 415360 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0015025800003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015025800002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015025800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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