Healthcare Provider Details

I. General information

NPI: 1912344615
Provider Name (Legal Business Name): BOARD OF DIRECTORS OF THE ROUSE ESTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-6750
  • Fax:
Mailing address:
  • Phone: 814-563-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSL008604
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN R WARMATH
Title or Position: DIRECTOR
Credential: PT, DPT
Phone: 814-563-6750