Provider Demographics
NPI:1205800992
Name:CONEMAUGH HEALTH COMPANY LLC
Entity type:Organization
Organization Name:CONEMAUGH HEALTH COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONEMAUGH HOME MEDICAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-534-4430
Mailing Address - Street 1:1015 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-534-4430
Mailing Address - Fax:814-534-4477
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-534-4430
Practice Address - Fax:814-534-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10146877702Medicaid
PA5490220001Medicare ID - Type UnspecifiedRETAIL STORE MC NUMBER