Provider Demographics
NPI:1912945098
Name:LOWER PROVIDENCE COMMUNITY CENTER
Entity Type:Organization
Organization Name:LOWER PROVIDENCE COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHLEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-539-8465
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19408
Mailing Address - Country:US
Mailing Address - Phone:610-539-8465
Mailing Address - Fax:610-539-8920
Practice Address - Street 1:101 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403
Practice Address - Country:US
Practice Address - Phone:610-539-8465
Practice Address - Fax:610-539-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03260341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010240160002Medicaid
PA200466Medicare ID - Type UnspecifiedMEDICARE