1770288698 NPI number — UNION COMMUNITY CARE

Table of content: (NPI 1770288698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770288698 NPI number — UNION COMMUNITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION COMMUNITY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELSH MOUNTAIN HEALTH CENTERS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770288698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 N WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-3374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-299-6371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 S ANN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-299-6371
Provider Business Practice Location Address Fax Number:
717-325-8057
Provider Enumeration Date:
03/31/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ALISA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
717-945-1551

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007614190025 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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