Healthcare Provider Details

I. General information

NPI: 1962602318
Provider Name (Legal Business Name): KEELING HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WOOD ST
CLARION PA
16214-1240
US

IV. Provider business mailing address

840 WOOD ST
CLARION PA
16214-1240
US

V. Phone/Fax

Practice location:
  • Phone: 814-393-2121
  • Fax: 814-393-2035
Mailing address:
  • Phone: 814-393-2121
  • Fax: 814-393-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUSAN BORNAK
Title or Position: DIRECTOR
Credential: CRNP
Phone: 814-393-2121