Basic Information
Provider Information
NPI: 1730250689
EntityType: 2
ReplacementNPI:  
OrganizationName: HOME NURSING AGENCY COMMUNITY SERVICES
LastName:  
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Mailing Information
Address1: 201 CHESTNUT AVE
Address2: PRIVATE DUTY
City: ALTOONA
State: PA
PostalCode: 166014927
CountryCode: US
TelephoneNumber: 8149465411
FaxNumber: 8149421673
Practice Location
Address1: 1216 PLEASANT VALLEY BOULEVARD
Address2: SUITE 208 - PRIVATE DUTY
City: ALTOONA
State: PA
PostalCode: 166024750
CountryCode: US
TelephoneNumber: 8149465411
FaxNumber: 8149408471
Other Information
ProviderEnumerationDate: 11/13/2006
LastUpdateDate: 04/24/2015
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: FREEMAN
AuthorizedOfficialFirstName: PHILIP
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8149465411
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
253Z00000X15283601PAY AgenciesIn Home Supportive Care 

ID Information
IDTypeStateIssuerDescription
100000765003905PA MEDICAID


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