Healthcare Provider Details

I. General information

NPI: 1851781249
Provider Name (Legal Business Name): OAK HRC BROAD MOUNTAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W LAUREL ST
FRACKVILLE PA
17931-2018
US

IV. Provider business mailing address

500 W LAUREL ST
FRACKVILLE PA
17931-2018
US

V. Phone/Fax

Practice location:
  • Phone: 570-874-0696
  • Fax:
Mailing address:
  • Phone: 570-874-0696
  • Fax:

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: HOWARD JAFFE
Title or Position: OFFICER
Credential:
Phone: 215-346-6454