Basic Information
| Provider Information | |||||||||
| NPI: | 1962166611 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRE GERIATRIC CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2134 SANDY DR STE 16 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Practice Location | |||||||||
| Address1: | 2134 SANDY DR STE 16 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | EILEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8143596866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.