Provider Demographics
NPI:1992868707
Name:POST ACUTE MEDICAL OUTPATIENT CLINICS LLC
Entity type:Organization
Organization Name:POST ACUTE MEDICAL OUTPATIENT CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:
Practice Address - Street 1:239 PARK ROAD 5091
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629
Practice Address - Country:US
Practice Address - Phone:830-672-6595
Practice Address - Fax:830-672-7446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POST ACUTE MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000702320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000702OtherDADS TYPE B
TX143026601Medicaid
TN000702OtherDADS TYPE B