Provider Demographics
NPI:1841475225
Name:AHI SKIN REJUVENATION CENTER
Entity type:Organization
Organization Name:AHI SKIN REJUVENATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STONICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:267-319-1530
Mailing Address - Street 1:1233 LOCUST STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-319-1530
Mailing Address - Fax:267-319-1531
Practice Address - Street 1:415 BUSINESS PARK LN
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9120
Practice Address - Country:US
Practice Address - Phone:267-319-1530
Practice Address - Fax:267-319-1531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AT HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021141200001Medicaid
PA1083814933OtherNPI ERIC
PA1021144150001Medicaid
PA1022406620001Medicaid
PA1021082020001Medicaid
PA1018007450002Medicaid
PA1021141200001Medicaid
PA136228Medicare PIN
PA1021144150001Medicaid
PA1018007450002Medicaid