Healthcare Provider Details

I. General information

NPI: 1659706166
Provider Name (Legal Business Name): THE SALVATION ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 MAIN STREET PO BOX 968
JOHNSTOWN PA
15907-0968
US

IV. Provider business mailing address

440 W NYACK RD
WEST NYACK NY
10994-1753
US

V. Phone/Fax

Practice location:
  • Phone: 814-539-3110
  • Fax: 814-536-4785
Mailing address:
  • Phone: 845-620-7200
  • Fax: 845-620-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025867L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL JOHN SOUTHWICK
Title or Position: SECRETARY
Credential:
Phone: 845-620-7329