=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386056265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFW NURSING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2014
-----------------------------------------------------
Last Update Date | 05/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 OAKRIDGE DRIVE
-----------------------------------------------------
City | MOUNTVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-522-1178
-----------------------------------------------------
Fax | 866-240-1131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 OAKRIDGE DR
-----------------------------------------------------
City | MOUNTVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17554-1867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-522-1178
-----------------------------------------------------
Fax | 866-240-1131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DON JAMES TRIOLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-522-1178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 25553601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------