Healthcare Provider Details

I. General information

NPI: 1770820920
Provider Name (Legal Business Name): HOUCK CARE AND CLEANING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 W COLLEGE AVE
STATE COLLEGE PA
16801-2646
US

IV. Provider business mailing address

19 COLONNADE WAY STE 117, PMB 291
STATE COLLEGE PA
16803-2319
US

V. Phone/Fax

Practice location:
  • Phone: 814-571-4544
  • Fax:
Mailing address:
  • Phone: 814-571-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11443601
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SHANNA SERVANT
Title or Position: MANAGER
Credential:
Phone: 814-571-4544