Healthcare Provider Details

I. General information

NPI: 1770745598
Provider Name (Legal Business Name): LTC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 02/24/2009
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: 570-785-3005
Mailing address:
  • Phone: 570-785-3005
  • Fax: 570-785-3005

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: DREW SPARKS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 570-785-3005