Provider Demographics
NPI:1578516894
Name:COMMUNITY NURSES HOME SUPPORT SERVICES
Entity Type:Organization
Organization Name:COMMUNITY NURSES HOME SUPPORT SERVICES
Other - Org Name:PENN HIGHLANDS HEALTHCARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-781-4784
Mailing Address - Street 1:757 JOHNSONBURG ROAD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-834-1842
Mailing Address - Fax:814-781-4732
Practice Address - Street 1:757 JOHNSONBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3488
Practice Address - Country:US
Practice Address - Phone:814-834-1842
Practice Address - Fax:814-781-4732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY NURSES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16663601253Z00000X
PA16783601253Z00000X, 385H00000X
PA16743601253Z00000X, 385H00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100005832-0009Medicaid
PA100005832-0110Medicaid
PA100005832-0012Medicaid
PA100005832-0011Medicaid
PA100005832-0012Medicaid
PA100005832-0011Medicaid