Provider Demographics
NPI:1912096041
Name:THE BAIR FOUNDATION OF PENNSYLVANIA
Entity Type:Organization
Organization Name:THE BAIR FOUNDATION OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESBENSHADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-946-8711
Mailing Address - Street 1:241 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1116
Mailing Address - Country:US
Mailing Address - Phone:724-946-8711
Mailing Address - Fax:724-946-3249
Practice Address - Street 1:615 HOWARD AVENUE
Practice Address - Street 2:EXECUTIVE HOUSE
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-941-5382
Practice Address - Fax:814-940-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA316390251B00000X
PA432940251B00000X
PA415360251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015025800003Medicaid
PA0015025800002Medicaid
PA0015025800001Medicaid