Provider Demographics
NPI:1578727012
Name:EASTER SEALS CENTRAL PA
Entity Type:Organization
Organization Name:EASTER SEALS CENTRAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-689-1911
Mailing Address - Street 1:501 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6410
Mailing Address - Country:US
Mailing Address - Phone:814-944-5014
Mailing Address - Fax:
Practice Address - Street 1:383 ROLLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7679
Practice Address - Country:US
Practice Address - Phone:814-689-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100002349Medicaid
PA396621Medicare Oscar/Certification