Healthcare Provider Details

I. General information

NPI: 1447245337
Provider Name (Legal Business Name): NORTHUMBERLAND COUNTY MOUNTAIN VIEW MANOR NURSING & REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 TREVORTON RD
COAL TOWNSHIP PA
17866-9405
US

IV. Provider business mailing address

2050 TREVORTON RD
COAL TOWNSHIP PA
17866-9405
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-4400
  • Fax: 570-644-4403
Mailing address:
  • Phone: 570-644-4400
  • Fax: 570-644-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number390302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ANN M CHAKLOS
Title or Position: ADMINISTRATOR
Credential: NURSING HOME ADMINIS
Phone: 570-644-4406