Healthcare Provider Details

I. General information

NPI: 1629376132
Provider Name (Legal Business Name): SANDC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 EAGLEVIEW BLVD SUITE 263
EXTON PA
19341
US

IV. Provider business mailing address

256 EAGLEVIEW BLVD SUITE 263
EXTON PA
19341-1157
US

V. Phone/Fax

Practice location:
  • Phone: 484-879-6573
  • Fax: 484-879-6576
Mailing address:
  • Phone: 484-879-6573
  • Fax: 484-879-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number18293601
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1022591900001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: COLLEEN FRANCES SLUSARCZYK
Title or Position: PRESIDENT
Credential:
Phone: 484-879-6573