Healthcare Provider Details

I. General information

NPI: 1366446288
Provider Name (Legal Business Name): ELLEN MEMORIAL HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ELLEN MEMORIAL LN
HONESDALE PA
18431-4096
US

IV. Provider business mailing address

23 ELLEN MEMORIAL LN
HONESDALE PA
18431-4096
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-5690
  • Fax: 570-253-9471
Mailing address:
  • Phone: 570-253-5690
  • Fax: 570-253-9471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number318502
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT G ZABADY
Title or Position: ADMINISTRATOR
Credential:
Phone: 570-253-5690