Provider Demographics
NPI:1285964528
Name:JANICE E. MANCINI RD LLC
Entity type:Organization
Organization Name:JANICE E. MANCINI RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:LDN
Authorized Official - Phone:724-255-3550
Mailing Address - Street 1:1200 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9696
Mailing Address - Country:US
Mailing Address - Phone:724-255-3550
Mailing Address - Fax:724-942-6650
Practice Address - Street 1:1200 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9696
Practice Address - Country:US
Practice Address - Phone:724-255-3550
Practice Address - Fax:724-942-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000105261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service