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NPI Code Detail

MEDICARE: ELLEN MEMORIAL, LLC

MEDICARE: ELLEN MEMORIAL, LLC
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 Facility

General Provider Information

NPI Number : 1942763297
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLEN MEMORIAL, LLC
Provider Business Mailing Address
First Line : 23 ELLEN MEMORIAL LN
Second Line :
City : HONESDALE
State : PA
Zip : 18431-4096
Country : US
Telephone Number : 570-253-5690
Fax Number :
Provider Business Practice Location Address
First Line : 23 ELLEN MEMORIAL LN
Second Line :
City : HONESDALE
State : PA
Zip : 18431-4096
Country : US
Telephone Number : 570-253-5690
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. JAMES MILLER
Credential : NHA
Telephone Number : 570-947-7043
Provider Enumeration Date : 04/12/2019
Last Update Date : 06/04/2024

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