Healthcare Provider Details

I. General information

NPI: 1508116062
Provider Name (Legal Business Name): RELIANT OSPREY HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NORTH SCOTT STREET
CARBONDALE PA
18407-1833
US

IV. Provider business mailing address

3601 ISLAND AVENUE
PHILADELPHIA PA
19153-3228
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-1099
  • Fax:
Mailing address:
  • Phone: 215-558-3700
  • Fax: 215-558-3701

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: THERESE JACKSON
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 215-558-3700