MEDICARE: LOWER PROVIDENCE COMMUNITY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	03260	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912945098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWER PROVIDENCE COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19408
Country	:	US
Telephone Number	:	610-539-8465
Fax Number	:	610-539-8920

Provider Business Practice Location Address
First Line	:	101 HILLSIDE AVE
Second Line	:
City	:	EAGLEVILLE
State	:	PA
Zip	:	19403
Country	:	US
Telephone Number	:	610-539-8465
Fax Number	:	610-539-8920

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GENA MARIE SCHLEGEL
Credential	:
Telephone Number	:	610-539-8465

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	10/09/2007

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Directions to “LOWER PROVIDENCE COMMUNITY CENTER ” Practice Location

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