Provider Demographics
NPI:1174505515
Name:AMERICAN HOME NURSING INC.
Entity Type:Organization
Organization Name:AMERICAN HOME NURSING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOPA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:570-969-2901
Mailing Address - Street 1:4113 BIRNEY AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1330
Mailing Address - Country:US
Mailing Address - Phone:570-969-2901
Mailing Address - Fax:570-969-2933
Practice Address - Street 1:4113 BIRNEY AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1330
Practice Address - Country:US
Practice Address - Phone:570-969-2901
Practice Address - Fax:570-969-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA770905251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014078510001Medicaid
PA39-7709Medicare ID - Type UnspecifiedHOME HEALTH AGENCY