Provider Demographics
NPI:1437440518
Name:FUSHION MEDICAL
Entity Type:Organization
Organization Name:FUSHION MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUPSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-690-0623
Mailing Address - Street 1:55 YATES ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4118
Mailing Address - Country:US
Mailing Address - Phone:570-690-0623
Mailing Address - Fax:
Practice Address - Street 1:15349 DAVENPORT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2043
Practice Address - Country:US
Practice Address - Phone:402-505-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006778310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility