Provider Demographics
NPI:1568441830
Name:HOLY REDEEMER PET ASSOCIATES LLC
Entity Type:Organization
Organization Name:HOLY REDEEMER PET ASSOCIATES LLC
Other - Org Name:MEADOWBROOK PET ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSTITUTIONAL RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-993-1640
Mailing Address - Street 1:43 LEOPARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1552
Mailing Address - Country:US
Mailing Address - Phone:610-993-1640
Mailing Address - Fax:610-993-1651
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-914-0501
Practice Address - Fax:215-914-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
064866Medicare ID - Type Unspecified