Healthcare Provider Details

I. General information

NPI: 1730203167
Provider Name (Legal Business Name): YOUR CHILD'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 NORTH AVE
WASHINGTON PA
15301-3512
US

IV. Provider business mailing address

190 N MAIN ST SUITE 306
WASHINGTON PA
15301-4349
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-7801
  • Fax: 724-223-7802
Mailing address:
  • Phone: 724-229-0851
  • Fax: 724-229-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL EALY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-229-0851