Healthcare Provider Details

I. General information

NPI: 1740723733
Provider Name (Legal Business Name): TRI-COUNTY NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 MAIN ST
BROCKWAY PA
15824-1325
US

IV. Provider business mailing address

426 MAIN ST
BROCKWAY PA
15824-1325
US

V. Phone/Fax

Practice location:
  • Phone: 814-265-0011
  • Fax: 814-265-0015
Mailing address:
  • Phone: 814-265-0011
  • Fax: 814-265-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number03590501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number03590501
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number03590501
License Number StatePA

VIII. Authorized Official

Name: MRS. PATRICIA DIANE REDMOND
Title or Position: OWNER
Credential:
Phone: 814-265-0011