Provider Demographics
NPI:1073675161
Name:ST. JOSEPH REGIONAL HEALTH NETWORK
Entity Type:Organization
Organization Name:ST. JOSEPH REGIONAL HEALTH NETWORK
Other - Org Name:ST. JOSEPH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-378-2300
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19603-0316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3501
Practice Address - Country:US
Practice Address - Phone:610-378-2560
Practice Address - Fax:610-378-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012591200001Medicaid