Basic Information
| Provider Information | |||||||||
| NPI: | 1285697268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHARON REGIONAL HEALTH SYSTEM | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SHARON REGIONAL HEALTH SYSTEM HOME HEALTH AGENCY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 32 JEFFERSON AVE STE 205 | ||||||||
| Address2: | SRHS HOME HEALTH AGENCY | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161463347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249833875 | ||||||||
| FaxNumber: | 7249833902 | ||||||||
| Practice Location | |||||||||
| Address1: | 32 JEFFERSON AVE STE 205 | ||||||||
| Address2: | SRHS HOME HEALTH AGENCY | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161463347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249833875 | ||||||||
| FaxNumber: | 7249833902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCKEE | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR BUSINESS OFFICE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7249833817 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHARON REGIONAL HEALTH SYSTEM | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPAM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251F00000X | 710205 | PA | N | Agencies | Home Infusion | 251B00000X | 710205 | PA | N | Agencies | Case Management | 251J00000X | 710205 | PA | N | Agencies | Nursing Care | 251V00000X | 710205 | PA | N | Agencies | Voluntary or Charitable | 251E00000X | 710205 | PA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0235427 | 05 | OH | MEDICAID | 1024667 | 01 | PA | GATEWAY | OTHER | 0748 | 01 | PA | BLUE CROSS | OTHER | 1000000590026 | 05 | PA | MEDICAID | 13178 | 01 | AETNA | OTHER | 156717 | 01 | ANTHEM | OTHER | 300046 | 01 | VALUE OPTIONS/HEALTH AMER | OTHER | 74525 | 01 | UNSION | OTHER |