Provider Demographics
NPI:1750431151
Name:ASSOCIATED GERIATRIC SERVICES INC
Entity type:Organization
Organization Name:ASSOCIATED GERIATRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-635-2535
Mailing Address - Street 1:4405 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROSSITER
Mailing Address - State:PA
Mailing Address - Zip Code:15772-7909
Mailing Address - Country:US
Mailing Address - Phone:814-938-3977
Mailing Address - Fax:813-938-7339
Practice Address - Street 1:1356 PERRY DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-8803
Practice Address - Country:US
Practice Address - Phone:717-488-8028
Practice Address - Fax:877-455-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7322777Medicaid
PA1820Medicare ID - Type Unspecified
PA001820Medicare PIN