=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891046215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HCBS SERVICE COORDINATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2012
-----------------------------------------------------
Last Update Date | 09/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 347 W MAIN ST
-----------------------------------------------------
City | TRAPPE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-256-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 347 W MAIN ST
-----------------------------------------------------
City | TRAPPE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19426-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-256-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SERVICE COORDINATION SUPERVISOR
-----------------------------------------------------
Name | MR. EDWARD EUGENE BROWN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 610-256-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------