Healthcare Provider Details

I. General information

NPI: 1700123684
Provider Name (Legal Business Name): SHARED SUPPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 N BROAD ST
COLMAR PA
18915-9725
US

IV. Provider business mailing address

2328 N BROAD ST
COLMAR PA
18915-9725
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-4982
  • Fax: 570-286-4984
Mailing address:
  • Phone: 570-286-4982
  • Fax: 570-286-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberAPPLIED FOR
License Number StatePA

VIII. Authorized Official

Name: THERESA E PRATT
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 570-286-4982