1962002204 NPI number — EXCELA HEALTH HOME CARE PRIVATE DUTY

Table of content: (NPI 1962002204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962002204 NPI number — EXCELA HEALTH HOME CARE PRIVATE DUTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELA HEALTH HOME CARE PRIVATE DUTY
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:
1962002204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 W OTTERMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-2126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-689-1800
Provider Business Mailing Address Fax Number:
724-689-1464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W OTTERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-689-1800
Provider Business Practice Location Address Fax Number:
724-689-1464
Provider Enumeration Date:
10/27/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIKO
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PATIENT ACCOUNT SUPERVISOR
Authorized Official Telephone Number:
724-689-1800

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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