Provider Demographics
NPI:1568632743
Name:HAMILTON HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HAMILTON HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-230-3906
Mailing Address - Street 1:110 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1123
Mailing Address - Country:US
Mailing Address - Phone:717-232-9971
Mailing Address - Fax:717-230-3914
Practice Address - Street 1:1301 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-3410
Practice Address - Country:US
Practice Address - Phone:717-230-3906
Practice Address - Fax:717-230-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007480790010Medicaid