Provider Demographics
NPI:1780711473
Name:PENNSYLVANIA ELKS MAJOR PROJECTS, INC.
Entity type:Organization
Organization Name:PENNSYLVANIA ELKS MAJOR PROJECTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:724-225-1395
Mailing Address - Street 1:1460 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8263
Mailing Address - Country:US
Mailing Address - Phone:724-225-1395
Mailing Address - Fax:724-225-1395
Practice Address - Street 1:1460 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8263
Practice Address - Country:US
Practice Address - Phone:724-225-1395
Practice Address - Fax:724-225-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN272919L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000012520005Medicaid