Provider Demographics
NPI:1639626872
Name:ACTIVATE HEALTHCARE - UTZ
Entity Type:Organization
Organization Name:ACTIVATE HEALTHCARE - UTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-697-3144
Mailing Address - Street 1:240 KINDIG LN
Mailing Address - Street 2:PLANT #5
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1732
Mailing Address - Country:US
Mailing Address - Phone:773-697-3144
Mailing Address - Fax:
Practice Address - Street 1:240 KINDIG LN
Practice Address - Street 2:PLANT #5
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1732
Practice Address - Country:US
Practice Address - Phone:773-697-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care