=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730306911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEOPLE IN NEED - LAWRENCE COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 11/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2703 W STATE ST
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16101-8671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-657-3303
-----------------------------------------------------
Fax | 724-657-3326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2703 W STATE ST
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16101-8671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-657-3303
-----------------------------------------------------
Fax | 724-657-3326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | SHARON HODGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-657-3303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 400930
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | 400930
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 400930
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 400930
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------