Healthcare Provider Details

I. General information

NPI: 1124014691
Provider Name (Legal Business Name): OLEAN GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PLEASANT STREET
BRADFORD PA
16701
US

IV. Provider business mailing address

200 PLEASANT STREET
BRADFORD PA
16701
US

V. Phone/Fax

Practice location:
  • Phone: 814-362-8599
  • Fax: 814-363-5110
Mailing address:
  • Phone: 814-362-8293
  • Fax: 814-363-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number024702
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0517
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGH MARK BLUE CROSS
# 2
Identifier1007507650046
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JILL M. OWENS
Title or Position: CEO
Credential: MD
Phone: 716-373-2600