Provider Demographics
NPI:1790274777
Name:SYDMOND HEALTH SERVICE INC
Entity Type:Organization
Organization Name:SYDMOND HEALTH SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-934-7165
Mailing Address - Street 1:1094 DIXON LN
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2431
Mailing Address - Country:US
Mailing Address - Phone:267-934-7165
Mailing Address - Fax:
Practice Address - Street 1:1094 DIXON LN
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-2431
Practice Address - Country:US
Practice Address - Phone:267-934-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA36483601Medicaid