Healthcare Provider Details

I. General information

NPI: 1104995877
Provider Name (Legal Business Name): ERIN J. FERGUSON CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-5002
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-5002
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-9018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14985
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: