Healthcare Provider Details

I. General information

NPI: 1275223117
Provider Name (Legal Business Name): VALERY MARYELLEN SQUARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CONESTOGA ST
STEELTON PA
17113-2263
US

IV. Provider business mailing address

155 CONESTOGA ST
STEELTON PA
17113-2263
US

V. Phone/Fax

Practice location:
  • Phone: 223-667-4238
  • Fax: 717-828-4845
Mailing address:
  • Phone: 223-667-4238
  • Fax: 717-828-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number96C08A27C81842EFBB39
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: