Healthcare Provider Details

I. General information

NPI: 1700163334
Provider Name (Legal Business Name): FCNRC, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 DELAWARE ST
FOREST CITY PA
18421-1005
US

IV. Provider business mailing address

915 DELAWARE ST
FOREST CITY PA
18421-1005
US

V. Phone/Fax

Practice location:
  • Phone: 570-785-3005
  • Fax: 570-785-9559
Mailing address:
  • Phone: 570-785-3005
  • Fax: 570-785-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061202
License Number StatePA

VIII. Authorized Official

Name: KIRK R REICHART
Title or Position: VICE PRESIDENT HEALTHCARE ADMIN
Credential:
Phone: 570-784-0111