Healthcare Provider Details

I. General information

NPI: 1356729073
Provider Name (Legal Business Name): BOARD OF DIRECTORS OF THE ROUSE ESTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-7565
  • Fax: 814-563-9049
Mailing address:
  • Phone: 814-563-7565
  • Fax: 814-563-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JASEN J DILEY
Title or Position: CEO
Credential:
Phone: 814-563-6403