Provider Demographics
NPI: | 1679708747 |
---|---|
Name: | FARRAH L ROSE |
Entity Type: | Organization |
Organization Name: | FARRAH L ROSE |
Other - Org Name: | ADVANCED TECH HEARING AID CENTERS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | FARRAH |
Authorized Official - Middle Name: | LEE |
Authorized Official - Last Name: | ROSE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BS, BC-HIS |
Authorized Official - Phone: | 570-523-5023 |
Mailing Address - Street 1: | 135 WALTER DR STE 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | LEWISBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17837-7411 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 570-523-5023 |
Mailing Address - Fax: | 570-523-5003 |
Practice Address - Street 1: | 135 WALTER DR STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | LEWISBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17837-7411 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-523-5023 |
Practice Address - Fax: | 570-523-5003 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-19 |
Last Update Date: | 2021-07-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | F03176 | 332S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332S00000X | Suppliers | Hearing Aid Equipment |