Healthcare Provider Details

I. General information

NPI: 1679194039
Provider Name (Legal Business Name): MIFFLIN JUNIATA AAA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 W 3RD ST
LEWISTOWN PA
17044-2004
US

IV. Provider business mailing address

249 W 3RD ST
LEWISTOWN PA
17044-2004
US

V. Phone/Fax

Practice location:
  • Phone: 717-320-8290
  • Fax:
Mailing address:
  • Phone: 717-320-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD P FITZGERALD
Title or Position: DIRECTOR
Credential: MS
Phone: 717-242-0315