Basic Information
Provider Information | |||||||||
NPI: | 1255810503 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UPMC HOME CARE MANAGMENT SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOME NURSING AGENCY COMMUNITY SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 352 | ||||||||
Address2: |   | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166030352 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149465411 | ||||||||
FaxNumber: | 8149408471 | ||||||||
Practice Location | |||||||||
Address1: | 501 HOWARD AVENUE, BUILDING B | ||||||||
Address2: | SUITE 110 | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166014927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149421403 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2018 | ||||||||
LastUpdateDate: | 05/26/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GRIFFITH | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 7247784606 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/26/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |   |
No ID Information.