Basic Information
| Provider Information | |||||||||
| NPI: | 1285792861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME NURSING AGENCY COMMUNITY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CHESTNUT AVE | ||||||||
| Address2: | EARLY INTERVENTION | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149465411 | ||||||||
| FaxNumber: | 8149411648 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LAKEMONT PARK BLVD | ||||||||
| Address2: | SUITE 100 EARLY INTERVENTION | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166025967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149460261 | ||||||||
| FaxNumber: | 8149436198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8149465411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 222Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225CX0006X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Orientation and Mobility Training Provider | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
ID Information
| ID | Type | State | Issuer | Description | 1000007650042 | 05 | PA | MEDICAID | 1000007650052 | 05 | PA | MEDICAID | 1000007650046 | 05 | PA | MEDICAID |