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Provider Demographic Information - ODP PROVIDER TWO

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Below Is the information you requested on the individual or agency ODP PROVIDER TWO. Select from the options on the right to view specific information of interest to you. As this information may change, please check back often for the most up-to-date information.

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	ODP PROVIDER TWO
Address:	2401 JOHN HENRY DR NEW CUMBERLAND, PA 17070-2123
Phone:	(717) 555-0002
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	Keystone Provr
Address:	200 beechwood lane harrisburg, PA 17011
Phone:	(222) 444-4444

Type:	Regional/Field Office	Counties Served:
Name:	ODP Provider Two Region Entity
Address:	300 city street harrisburg, PA 17011
Phone:	(717) 555-5555

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Venango
\|Service Name / Level	\|Rate

3034 AddService	Not Set
Occupational Therapy-15 min	Not Set

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