Provider Demographics
NPI:1346304714
Name:PERITECH - NURSE FAMILY PARTNERSHIP
Entity Type:Organization
Organization Name:PERITECH - NURSE FAMILY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:I
Authorized Official - Credentials:RNC BSN
Authorized Official - Phone:814-375-2703
Mailing Address - Street 1:5753 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-375-2703
Mailing Address - Fax:
Practice Address - Street 1:5753 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-375-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA763005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016049300001Medicaid
PA1016051140001Medicaid
PA0015147050003Medicaid
PA1016052210001Medicaid
PA1016049770001Medicaid
PA1016050250001Medicaid