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General NPI Number Information
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NPI Number | 1487906632
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Entity Type | Organization
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Legal Business Name | PROSTAT, INC.
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 1901 BERNVILLE RD
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City | READING
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State | PA
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Zip | 19601-1113
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Country | US
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Telephone | 610-736-9000
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Fax | 610-736-9006
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Provider Business Mailing Address
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Address Line | 395 E BROAD ST
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City | TAMAQUA
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State | PA
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Zip | 18252-2145
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Country | US
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Telephone | 570-225-7090
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Fax | 570-225-7097
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Authorized Official
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Title or Position | COO
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Name | MR. DAVID EUGENE SHELLY
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Credential |
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Telephone | 570-225-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 23393601
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License Number State | PA
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