Healthcare Provider Details

I. General information

NPI: 1538684220
Provider Name (Legal Business Name): HOLCOMB ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 EAST BALTIMORE PIKE GAYLEY SQUARE
MEDIA PA
19063
US

IV. Provider business mailing address

467 CREAMERY WAY
EXTON PA
19341-2508
US

V. Phone/Fax

Practice location:
  • Phone: 484-444-0412
  • Fax: 484-444-0421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROGER OSMUN
Title or Position: COO
Credential: PHD
Phone: 610-363-1488