Provider Demographics
NPI:1043362288
Name:HANOVER HEALTH CORPORATION, INC.
Entity Type:Organization
Organization Name:HANOVER HEALTH CORPORATION, INC.
Other - Org Name:DAVID L. CROOKS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLEJNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-637-3711
Mailing Address - Street 1:300 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2297
Mailing Address - Country:US
Mailing Address - Phone:717-633-3511
Mailing Address - Fax:717-646-0188
Practice Address - Street 1:310 STOCK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-646-7165
Practice Address - Fax:717-646-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777780013Medicaid
PAPENDINGMedicare ID - Type Unspecified