Provider Demographics
NPI:1447210034
Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CORRY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:CORRY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KECER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-664-4641
Mailing Address - Street 1:612 W SMITH ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1152
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:814-664-8799
Practice Address - Street 1:612 W SMITH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1152
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:814-664-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397201Medicare ID - Type UnspecifiedHOME HEALTH