Healthcare Provider Details

I. General information

NPI: 1326384090
Provider Name (Legal Business Name): SUPPORTS COORDINATION GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 OREGON PIKE
LANCASTER PA
17601-4604
US

IV. Provider business mailing address

2141 OREGON PIKE
LANCASTER PA
17601-4604
US

V. Phone/Fax

Practice location:
  • Phone: 717-598-2871
  • Fax:
Mailing address:
  • Phone: 717-598-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIFFANY JUDGE
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 717-598-2871