Provider Demographics
NPI:1053658039
Name:SERVICE COORDINATION OF SOUTH CENTRAL PA
Entity Type:Organization
Organization Name:SERVICE COORDINATION OF SOUTH CENTRAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-5552
Mailing Address - Street 1:101 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-1226
Mailing Address - Country:US
Mailing Address - Phone:717-632-5552
Mailing Address - Fax:717-632-2315
Practice Address - Street 1:788 CHERRY TREE CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7901
Practice Address - Country:US
Practice Address - Phone:717-632-5552
Practice Address - Fax:717-632-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027106240001OtherMA- ADULT AUSTISM WAIVER