Provider Demographics
NPI:1861123432
Name:GEORGE JUNIOR REPUBLIC IN PENNSYL VANIA
Entity type:Organization
Organization Name:GEORGE JUNIOR REPUBLIC IN PENNSYL VANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW MBA
Authorized Official - Phone:724-458-9330
Mailing Address - Street 1:233 GEORGE JUNIOR RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4417
Mailing Address - Country:US
Mailing Address - Phone:724-458-9330
Mailing Address - Fax:724-458-0389
Practice Address - Street 1:233 GEORGE JUNIOR RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4417
Practice Address - Country:US
Practice Address - Phone:724-458-9330
Practice Address - Fax:724-458-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014522190134Medicaid