Provider Demographics
NPI:1114184785
Name:COMMUNITY WOMENS CARE OF BERKS COUNTY
Entity Type:Organization
Organization Name:COMMUNITY WOMENS CARE OF BERKS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:DIECKMANN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSM,CNM
Authorized Official - Phone:610-781-7040
Mailing Address - Street 1:1017 DURYEA AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1159
Mailing Address - Country:US
Mailing Address - Phone:610-926-6424
Mailing Address - Fax:610-370-2504
Practice Address - Street 1:15200 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9335
Practice Address - Country:US
Practice Address - Phone:610-683-4646
Practice Address - Fax:610-683-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008557L176B00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021823710001Medicaid
PA1021823710002Medicaid
PA1010123680002OtherMAID#