Healthcare Provider Details

I. General information

NPI: 1861518839
Provider Name (Legal Business Name): MOUNTAIN CITY HEALTH & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 27TH ST
HAZLETON PA
18202-9604
US

IV. Provider business mailing address

525 FELLOWSHIP RD SUITE 360
MOUNT LAUREL NJ
08054-3415
US

V. Phone/Fax

Practice location:
  • Phone: 856-813-2000
  • Fax: 856-813-2020
Mailing address:
  • Phone: 856-813-2000
  • Fax: 856-813-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number085602
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0017458740001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CHERYL BURKE
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 856-813-2000