Provider Demographics
NPI:1841837218
Name:HERNANDEZ, FELIX
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1210
Mailing Address - Country:US
Mailing Address - Phone:570-291-8891
Mailing Address - Fax:570-293-5355
Practice Address - Street 1:814 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1210
Practice Address - Country:US
Practice Address - Phone:570-291-8891
Practice Address - Fax:570-293-5355
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA45623601311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home