Healthcare Provider Details

I. General information

NPI: 1982800967
Provider Name (Legal Business Name): BERWICK HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 16TH ST
BERWICK PA
18603-2440
US

IV. Provider business mailing address

P O BOX 503171
ST LOUIS MO
63150-3171
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-5000
  • Fax: 570-759-3473
Mailing address:
  • Phone: 570-759-5000
  • Fax: 570-759-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number281102
License Number StatePA

VIII. Authorized Official

Name: GARY D NEWSOME
Title or Position: PRESIDENT
Credential:
Phone: 615-465-7000