Provider Demographics
NPI:1528024999
Name:CHILDREN'S BRACE, INC.
Entity Type:Organization
Organization Name:CHILDREN'S BRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:717-790-0600
Mailing Address - Street 1:710 S YORK ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4745
Mailing Address - Country:US
Mailing Address - Phone:717-790-0600
Mailing Address - Fax:717-790-0617
Practice Address - Street 1:475 W GOVERNOR RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2217
Practice Address - Country:US
Practice Address - Phone:717-790-0600
Practice Address - Fax:717-790-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005984335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019006770001Medicaid
PA0019006770001Medicaid