Provider Demographics
NPI:1801070784
Name:EPHRATA COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:EPHRATA COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAELLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-733-0405
Mailing Address - Street 1:1215 RIDGE AVE.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9782
Mailing Address - Country:US
Mailing Address - Phone:717-335-0696
Mailing Address - Fax:717-335-2332
Practice Address - Street 1:600 E PENN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1622
Practice Address - Country:US
Practice Address - Phone:610-898-8088
Practice Address - Fax:610-898-8184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPHRATA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA310301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000124064OtherUNISON
PA0010981270004Medicaid
PA217220OtherHEALTH ASSURANCE
PA1000856OtherAMERIHEALTH MERCY
PA0533068OtherAETNA
PA1519615OtherGATEWAY
PA39HA37OtherCAPITAL BLUE CROSS
PA000207557OtherHIGHMARK
PA0442600003Medicare NSC