Provider Demographics
NPI:1912061672
Name:HOMEMAKER-HOME HEALTH AIDE SERVICE OF BEAVER COUNTY, INC.
Entity Type:Organization
Organization Name:HOMEMAKER-HOME HEALTH AIDE SERVICE OF BEAVER COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:724-774-4002
Mailing Address - Street 1:376 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2917
Mailing Address - Country:US
Mailing Address - Phone:724-774-4002
Mailing Address - Fax:724-774-7703
Practice Address - Street 1:376 MARKET ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2917
Practice Address - Country:US
Practice Address - Phone:724-774-4002
Practice Address - Fax:724-774-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001849986Medicaid