Provider Demographics
NPI:1942555263
Name:EXPERIENCE, INC.
Entity Type:Organization
Organization Name:EXPERIENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-723-3763
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-0886
Mailing Address - Country:US
Mailing Address - Phone:814-723-3763
Mailing Address - Fax:814-723-3271
Practice Address - Street 1:905 4TH AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1802
Practice Address - Country:US
Practice Address - Phone:814-723-3763
Practice Address - Fax:814-723-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018423210001Medicaid