Basic Information
Provider Information | |||||||||
NPI: | 1144536632 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HUNTINGDON NURSING AND REHABILITATION CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1229 WARM SPRINGS AVE | ||||||||
Address2: |   | ||||||||
City: | HUNTINGDON | ||||||||
State: | PA | ||||||||
PostalCode: | 166522350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8146434210 | ||||||||
FaxNumber: | 8146438175 | ||||||||
Practice Location | |||||||||
Address1: | 1229 WARM SPRINGS AVE | ||||||||
Address2: |   | ||||||||
City: | HUNTINGDON | ||||||||
State: | PA | ||||||||
PostalCode: | 166522350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8146434210 | ||||||||
FaxNumber: | 8146438175 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2010 | ||||||||
LastUpdateDate: | 08/23/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FUNK | ||||||||
AuthorizedOfficialFirstName: | LAURIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8146434210 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HUNTINGDON NURSING CENTER INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 10075640000003 | 05 | PA |   | MEDICAID |