Healthcare Provider Details

I. General information

NPI: 1639151145
Provider Name (Legal Business Name): DUNMORE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MILL ST
DUNMORE PA
18512-3069
US

IV. Provider business mailing address

1000 MILL ST
DUNMORE PA
18512-3069
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-7624
  • Fax: 570-342-5476
Mailing address:
  • Phone: 570-342-7624
  • Fax: 570-342-5476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier0018138490002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ELLEN CRAVEN
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 570-342-7624