Provider Demographics
NPI:1427034230
Name:MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL
Other - Org Name:HOMECARE OF YORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MHA
Authorized Official - Phone:717-849-5635
Mailing Address - Street 1:1412 SIXTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2648
Mailing Address - Country:US
Mailing Address - Phone:717-849-5635
Mailing Address - Fax:717-849-5630
Practice Address - Street 1:1412 6TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2648
Practice Address - Country:US
Practice Address - Phone:717-849-5635
Practice Address - Fax:717-849-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA747405251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007293960040Medicaid
PA1007293960040Medicaid