Provider Demographics
NPI:1679062467
Name:
Entity Type:Organization
Organization Name:
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIMIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-343-3151
Mailing Address - Street 1:327 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4609
Mailing Address - Country:US
Mailing Address - Phone:802-343-3151
Mailing Address - Fax:
Practice Address - Street 1:327 DEVON DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4609
Practice Address - Country:US
Practice Address - Phone:802-343-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care