Basic Information
| Provider Information | |||||||||
| NPI: | 1518058726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPT OF MILITARY AFFAIRS, COMMONWEALTH OF PENNSYLVANIA | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOLLIDAYSBURG VETERANS HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | P. O. BOX 319 | ||||||||
| Address2: | OLD RT. 220 AND MEADOWS INTERSECTION | ||||||||
| City: | HOLLIDAYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166480319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146965201 | ||||||||
| FaxNumber: | 8146965346 | ||||||||
| Practice Location | |||||||||
| Address1: | OLD RT. 220 AND MEADOWS INTERSECTION | ||||||||
| Address2: | |||||||||
| City: | HOLLIDAYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166480319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146965201 | ||||||||
| FaxNumber: | 8146965346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FISCAL SERVICES ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8142427789 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2865M2000X | 341402 | PA | N | Hospitals | Military Hospital | Military General Acute Care Hospital | 313M00000X | 341402 | PA | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.