Basic Information
| Provider Information | |||||||||
| NPI: | 1346490158 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDICAL STAFFING ASSOCIATES, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | HEART 2 HEART HOME HEALTH AGENCY/HEART 2 HEART HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 659 3RD ST | ||||||||
| Address2: | UPPER SUITE | ||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150092115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247751118 | ||||||||
| FaxNumber: | 7247752375 | ||||||||
| Practice Location | |||||||||
| Address1: | 659 3RD ST | ||||||||
| Address2: | UPPER SUITE | ||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150092115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247751118 | ||||||||
| FaxNumber: | 7247752375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 05/10/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUTERA | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7247751118 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CDP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 164W00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 251J00000X | Y | Agencies | Nursing Care |
ID Information
| ID | Type | State | Issuer | Description | 101216813 | 05 | PA | MEDICAID |