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NPI Code Detail

MEDICARE: LYCOMING COMMUNITY CARE INC

MEDICARE: LYCOMING COMMUNITY CARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility027602PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306883210
Entity Type Code : Organization
Provider Name (Legal Business Name) : LYCOMING COMMUNITY CARE INC
Provider Business Mailing Address
First Line : 2140 WARRENSVILLE RD
Second Line :
City : MONTOURSVILLE
State : PA
Zip : 17754-9621
Country : US
Telephone Number : 570-433-3161
Fax Number : 570-433-3882
Provider Business Practice Location Address
First Line : 2140 WARRENSVILLE RD
Second Line :
City : MONTOURSVILLE
State : PA
Zip : 17754-9621
Country : US
Telephone Number : 570-433-3161
Fax Number : 570-433-3882
Authorized Official
Title or Position : CFO
Name : MR. STEPHEN D FRY
Credential :
Telephone Number : 570-433-3161
Provider Enumeration Date : 05/31/2006
Last Update Date : 06/01/2015

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Directions to “LYCOMING COMMUNITY CARE INC ” Practice Location

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