Provider Demographics
NPI:1962702308
Name:COMMUNITY NURSING PRIVATE CARE, INC
Entity type:Organization
Organization Name:COMMUNITY NURSING PRIVATE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-534-4450
Mailing Address - Street 1:2447 BEDFORD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1405
Mailing Address - Country:US
Mailing Address - Phone:814-254-4247
Mailing Address - Fax:814-534-4454
Practice Address - Street 1:2447 BEDFORD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1405
Practice Address - Country:US
Practice Address - Phone:814-254-4247
Practice Address - Fax:814-534-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20733601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care