Provider Demographics
NPI:1083685622
Name:COATESVILLE HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:COATESVILLE HOSPITAL CORPORATION
Other - Org Name:BRANDYWINE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:PO BOX 503540
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-3540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 REECEVILLE RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1542
Practice Address - Country:US
Practice Address - Phone:610-383-8000
Practice Address - Fax:610-383-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025801282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001750000OtherBC ANTHEM
0071888101OtherAMERICHOICE
1007751290010OtherCOMMUNITY CARE BEHAVIORAL
2518584OtherAETNA
0001750000OtherHIGHMARK BC
0001750000OtherBCBS
0001750000OtherBC CAPITAL
124571000OtherMAGELLAN KHPE
153185OtherMAGELLAN
60064OtherAMERIHEALTH MERCY
60064OtherKEYSTONE MERCY
PA1007751290005Medicaid
0001750000OtherAMERIHEALTH
08281OtherHEALTH PARTNERS
PA1007751290011Medicaid
0071888101OtherAMERICHOICE