MEDICARE: MENNO HAVEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1144217738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENNO HAVEN INC

Provider Business Mailing Address
First Line	:	1425 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1386
Country	:	US
Telephone Number	:	717-261-4194
Fax Number	:	717-261-4319

Provider Business Practice Location Address
First Line	:	1425 PHILADELPHIA AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1386
Country	:	US
Telephone Number	:	717-261-4194
Fax Number	:	717-261-4319

Authorized Official
Title or Position	:	CFO
Name	:	MS. ANA CRIDER
Credential	:
Telephone Number	:	717-262-1000

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/03/2008

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