Provider Demographics
NPI:1154567444
Name:REGIONAL HEALTH CENTRAL LLC
Entity type:Organization
Organization Name:REGIONAL HEALTH CENTRAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-877-3431
Mailing Address - Street 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-6000
Mailing Address - Fax:814-877-5696
Practice Address - Street 1:1700 PEACH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2134
Practice Address - Country:US
Practice Address - Phone:814-452-3585
Practice Address - Fax:814-454-1606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty