Provider Demographics
NPI:1467619452
Name:COUNTY OF MONTGOMERY HOUSE STAFF
Entity Type:Organization
Organization Name:COUNTY OF MONTGOMERY HOUSE STAFF
Other - Org Name:PARKHOUSE PROVIDENCE POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBLASE
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:610-792-2224
Mailing Address - Street 1:1600 BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3147
Mailing Address - Country:US
Mailing Address - Phone:610-792-2224
Mailing Address - Fax:
Practice Address - Street 1:1600 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3147
Practice Address - Country:US
Practice Address - Phone:610-792-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKHOUSE PROVIDENCE POINTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1417904897OtherNPI
PAP00353119OtherRAILROAD
PA970001552OtherRAILROAD
PA080140805OtherRAILROAD
PA1962412791OtherNPI
PAMA000727LOtherLICENSE
PAP00353128OtherRAILROAD
PAOS006559LOtherLICENSE
PA010062489OtherRAILROAD #
PA080140805OtherRAILROAD #
PAOS008998LOtherLICENSE
PA1194769596OtherNPI
PAMA000404LOtherLICENSE
PAOS008196LOtherLICENSE
PA080154916OtherRAILROAD #
PA1093753949OtherNPI
PA177908OtherPROVIDER #
PA1710029335OtherNPI
PA1194769596OtherNPI
PA022414Medicare UPIN
PA010062489OtherRAILROAD #
PA1962412791OtherNPI
PAP00353128OtherRAILROAD
PAMA000404LOtherLICENSE
PA080140805OtherRAILROAD #
PA094944GGMMedicare PIN
PAOS008196LOtherLICENSE
PAH55619Medicare UPIN
PA785606GGMMedicare PIN
PA082504GGMMedicare PIN