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General NPI Number Information
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NPI Number | 1487169330
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Entity Type | Organization
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Legal Business Name | CONNELLSVILLE AREA SENIOR TIGERS, INC
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 100 E FAYETTE ST
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3334
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Country | US
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Telephone | 724-626-1515
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Fax | 724-628-4701
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Provider Business Mailing Address
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Address Line | 100 E FAYETTE ST
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3334
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Country | US
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Telephone | 724-626-1515
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Fax | 724-628-4701
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA PRITTS
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Credential |
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Telephone | 724-626-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State | PA
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