Healthcare Provider Details

I. General information

NPI: 1609548858
Provider Name (Legal Business Name): GLEN BROOK REHABILITATION AND HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 16TH ST
BERWICK PA
18603-2314
US

IV. Provider business mailing address

801 E 16TH ST
BERWICK PA
18603-2314
US

V. Phone/Fax

Practice location:
  • Phone: 570-802-9060
  • Fax: 570-802-9023
Mailing address:
  • Phone: 570-802-9060
  • Fax: 570-802-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MOSHE A STERN
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 848-249-7952