Healthcare Provider Details

I. General information

NPI: 1912315649
Provider Name (Legal Business Name): LOYALSOCK CREEK SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SYCAMORE RD
MONTOURSVILLE PA
17754-9519
US

IV. Provider business mailing address

1445 SYCAMORE RD
MONTOURSVILLE PA
17754-9519
US

V. Phone/Fax

Practice location:
  • Phone: 570-601-8100
  • Fax:
Mailing address:
  • Phone: 570-601-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MOSHE SCHEINER
Title or Position: MEMBER
Credential:
Phone: 845-490-6060