Basic Information
| Provider Information | |||||||||
| NPI: | 1740414416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SADLER HEALTH CENTER CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170132421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 MONTOUR RD | ||||||||
| Address2: | |||||||||
| City: | LOYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170479200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 09/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | RICHARD | ||||||||
| AuthorizedOfficialFirstName: | MITZI | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE/BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7179604325 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SADLER HEALTH CENTER CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0019445370005 | 05 | PA | MEDICAID |