Provider Demographics
NPI:1952598658
Name:HANOVER HEALTH CORPORATION, INC.
Entity Type:Organization
Organization Name:HANOVER HEALTH CORPORATION, INC.
Other - Org Name:PHYSICAL MEDICINE SPECIALIST OF HANOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLEJNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-633-3511
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-646-6915
Mailing Address - Fax:717-646-6919
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-646-6915
Practice Address - Fax:717-646-6919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANOVER HEALTH CORPORATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777780013Medicaid
PA1007777780013Medicaid