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General NPI Number Information
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NPI Number | 1700123684
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Entity Type | Organization
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Legal Business Name | SHARED SUPPORT, INC.
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 2328 N BROAD ST
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City | COLMAR
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State | PA
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Zip | 18915-9725
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Country | US
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Telephone | 570-286-4982
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Fax | 570-286-4984
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Provider Business Mailing Address
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Address Line | 2328 N BROAD ST
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City | COLMAR
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State | PA
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Zip | 18915-9725
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Country | US
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Telephone | 570-286-4982
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Fax | 570-286-4984
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Authorized Official
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Title or Position | FISCAL DIRECTOR
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Name | THERESA E PRATT
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Credential |
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Telephone | 570-286-4982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | APPLIED FOR
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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