Provider Demographics
NPI:1689961740
Name:LARSON ENTERPRISE, INC
Entity Type:Organization
Organization Name:LARSON ENTERPRISE, INC
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-322-1414
Mailing Address - Street 1:353 PINE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6257
Mailing Address - Country:US
Mailing Address - Phone:570-322-1414
Mailing Address - Fax:570-329-3693
Practice Address - Street 1:353 PINE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6257
Practice Address - Country:US
Practice Address - Phone:570-322-1414
Practice Address - Fax:570-329-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10103601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care