Basic Information
| Provider Information | |||||||||
| NPI: | 1386607125 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHARON REGIONAL HEALTH SYSTEM | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SRHS HOSPICE/PALLIATIVE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 699 E STATE ST | ||||||||
| Address2: | SRHS BUSINESS OFFICE | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161462057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249833820 | ||||||||
| FaxNumber: | 7249833941 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 HIGHLAND RD | ||||||||
| Address2: | CANCER CARE CENTER | ||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161482819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249833878 | ||||||||
| FaxNumber: | 7249835949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHROBAK | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FOR FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7249833815 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHARON REGIONAL HEALTH SYSTEM | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 153999 | PA | N | Agencies | Home Health | 251J00000X | 153999 | PA | N | Agencies | Nursing Care | 251G00000X | 153999 | PA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 300046 | 01 | VALUE OPTIONS/HEALTH AMER | OTHER | 1013 | 01 | PA BLUE CROSS | OTHER | 1000000590004 | 05 | PA | MEDICAID | 13178 | 01 | AETNA | OTHER | 000000156716 | 01 | ANTHEM | OTHER |