Provider Demographics
NPI:1568645448
Name:EPHRATA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Name:ECH-DIETARY/THE WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-738-6407
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:69 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9203
Practice Address - Country:US
Practice Address - Phone:717-721-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007464680125Medicaid