Healthcare Provider Details

I. General information

NPI: 1962796029
Provider Name (Legal Business Name): BOARD OF DIRECTORS OF THE ROUSE ESTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 4TH AVE
WARREN PA
16365-1802
US

IV. Provider business mailing address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-1116
  • Fax:
Mailing address:
  • Phone: 814-563-6421
  • Fax: 814-563-9049

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. JEFFREY A SEDON
Title or Position: CFO
Credential:
Phone: 814-563-6421