Basic Information
| Provider Information | |||||||||
| NPI: | 1346696614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME NURSING AGENCY COMMUNITY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CHESTNUT AVE | ||||||||
| Address2: | PO BOX 352 | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149465411 | ||||||||
| FaxNumber: | 8149408471 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 CHESTNUT AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149411389 | ||||||||
| FaxNumber: | 8149408471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2016 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8149465411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | 15283601 | PA | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | 1000007650070 | 05 | PA | MEDICAID |