Provider Demographics
NPI:1962796029
Name:BOARD OF DIRECTORS OF THE ROUSE ESTATE
Entity type:Organization
Organization Name:BOARD OF DIRECTORS OF THE ROUSE ESTATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-563-6421
Mailing Address - Street 1:701 ROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16371-1605
Mailing Address - Country:US
Mailing Address - Phone:814-563-6421
Mailing Address - Fax:814-563-9049
Practice Address - Street 1:905 4TH AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1802
Practice Address - Country:US
Practice Address - Phone:814-726-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care