Provider Demographics
NPI:1548239536
Name:YORK HEALTH BOUTIQUE FOR WOMEN
Entity Type:Organization
Organization Name:YORK HEALTH BOUTIQUE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. (OWNER)
Authorized Official - Prefix:MRS
Authorized Official - First Name:URITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAVETAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-741-0127
Mailing Address - Street 1:180 LEADERS HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4742
Mailing Address - Country:US
Mailing Address - Phone:717-741-0127
Mailing Address - Fax:717-741-0168
Practice Address - Street 1:180 LEADERS HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4742
Practice Address - Country:US
Practice Address - Phone:717-741-0127
Practice Address - Fax:717-741-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005630332BC3200X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA211107OtherHIGHMARK BLUE SHIELD
PA39HA96OtherCAPITAL BLUE CROSS
PA123905OtherUNISON/THREE RIVERS/MEDPL
PA0018221500002Medicaid
PA20022585OtherAMERI HEALTH MERCY
PA1315400001Medicare NSC