Provider Demographics
NPI:1447861521
Name:MATURE RESOURCES FOUNDATION
Entity type:Organization
Organization Name:MATURE RESOURCES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-765-2696
Mailing Address - Street 1:PO BOX 986500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28944 FRENCHVILLE KARTHAUS HWY
Practice Address - Street 2:
Practice Address - City:FRENCHVILLE
Practice Address - State:PA
Practice Address - Zip Code:16836-8834
Practice Address - Country:US
Practice Address - Phone:814-765-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty