Provider Demographics
NPI:1932182821
Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Entity Type:Organization
Organization Name:PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
Other - Org Name:ALTOONA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-472-7350
Mailing Address - Street 1:1515 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4532
Mailing Address - Country:US
Mailing Address - Phone:814-472-0200
Mailing Address - Fax:814-472-0542
Practice Address - Street 1:1515 4TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4532
Practice Address - Country:US
Practice Address - Phone:814-472-0200
Practice Address - Fax:814-472-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA736087Medicare ID - Type UnspecifiedCLINICAL SERVICES
PACK4681Medicare PIN