Healthcare Provider Details

I. General information

NPI: 1184805038
Provider Name (Legal Business Name): EXC., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 MAIN ST REAR
BENTLEYVILLE PA
15314-1214
US

IV. Provider business mailing address

808 MAIN ST
BENTLEYVILLE PA
15314-1214
US

V. Phone/Fax

Practice location:
  • Phone: 724-239-2211
  • Fax: 724-239-2233
Mailing address:
  • Phone: 724-239-2211
  • Fax: 724-239-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number406440
License Number StatePA

VIII. Authorized Official

Name: MR. ANDREW F KUZY
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 724-239-2211