Provider Demographics
NPI:1962166611
Name:CENTRE GERIATRIC CARE, LLC
Entity type:Organization
Organization Name:CENTRE GERIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-359-6866
Mailing Address - Street 1:2134 SANDY DR STE 16
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2292
Mailing Address - Country:US
Mailing Address - Phone:814-272-5805
Mailing Address - Fax:814-272-0110
Practice Address - Street 1:2134 SANDY DR STE 16
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2292
Practice Address - Country:US
Practice Address - Phone:814-272-5805
Practice Address - Fax:814-272-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty