Provider Demographics
NPI:1902860885
Name:HANOVER HEALTH CORPORATION INC
Entity Type:Organization
Organization Name:HANOVER HEALTH CORPORATION INC
Other - Org Name:SOUTH HANOVER FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLEJNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-637-3711
Mailing Address - Street 1:300 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-633-3511
Mailing Address - Fax:717-646-0188
Practice Address - Street 1:1404 BALTIMORE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8698
Practice Address - Country:US
Practice Address - Phone:717-637-0470
Practice Address - Fax:717-637-4987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANOVER HEALTH CORPORATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-17
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
098943Medicare ID - Type Unspecified