Provider Demographics
NPI:1083828214
Name:CRAWFORD COUNTY CARE CENTER
Entity Type:Organization
Organization Name:CRAWFORD COUNTY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-763-2445
Mailing Address - Street 1:20881 HIGHWAY 198
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-6159
Mailing Address - Country:US
Mailing Address - Phone:814-763-2445
Mailing Address - Fax:
Practice Address - Street 1:20881 HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433-6159
Practice Address - Country:US
Practice Address - Phone:814-763-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0928490001OtherDME SUPPLIER NUMBER