Healthcare Provider Details

I. General information

NPI: 1598832008
Provider Name (Legal Business Name): WALNUT MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9617 LINCOLN HWY STE 109
BEDFORD PA
15522-3712
US

IV. Provider business mailing address

226 MAIN ST
JOHNSTOWN PA
15901-1509
US

V. Phone/Fax

Practice location:
  • Phone: 814-624-0669
  • Fax: 814-624-0679
Mailing address:
  • Phone: 814-533-0901
  • Fax: 814-533-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3000007084
License Number StatePA

VIII. Authorized Official

Name: MRS. JODI RENE CLARK
Title or Position: CEO
Credential:
Phone: 814-533-0901