NPIMap

Organization Active NPI

Ehpp Chestnut Ridge LLC

Doing business as Excela Chestnut Ridge Blairsville

  • Non-Pharmacy Dispensing Site
  • Blairsville, PA
National Provider Identifier
1093952251
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD026304E Issued in PA
Legal business name
EHPP CHESTNUT RIDGE LLC
Doing business as
Excela Chestnut Ridge Blairsville
Practice address
56 Club LN
Suite 203
Blairsville, PA 15717-7957
Phone
(724) 459-7338
NPI assigned
Jan 9, 2009
Last updated
Jul 8, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD026304E PA Primary

Addresses

Primary practice location

56 Club LN
Suite 203
Blairsville, PA 15717-7957

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Excela Chestnut Ridge Blairsville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ehpp Chestnut Ridge LLC8 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1093952251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 CLUB LN",
            "address_2": "SUITE 203",
            "city": "BLAIRSVILLE",
            "state": "PA",
            "postal_code": "157177957",
            "telephone_number": "724-459-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EHPP CHESTNUT RIDGE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2009-01-09",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "PA",
            "license": "MD026304E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excela Chestnut Ridge Blairsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blairsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.