Provider Demographics
NPI:1922050384
Name:TAKE CARE HEALTH PENNSYLVANIA, PC
Entity Type:Organization
Organization Name:TAKE CARE HEALTH PENNSYLVANIA, PC
Other - Org Name:TAKE CARE HEALTH PENNSYLVANIA, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-925-4733
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 640
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:844-925-4733
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:100 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2214
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:217-709-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016793050011Medicaid
PA128999Medicare PIN
PA1016793050011Medicaid