Healthcare Provider Details

I. General information

NPI: 1326337528
Provider Name (Legal Business Name): NANTICOKE HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W WASHINGTON ST
NANTICOKE PA
18634-3113
US

IV. Provider business mailing address

128 W WASHINGTON ST
NANTICOKE PA
18634-3113
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-7100
  • Fax: 570-348-7696
Mailing address:
  • Phone: 570-348-7100
  • Fax: 570-348-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number141401
License Number StatePA

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTH REP / DIR BUS OFFICE SUPPORT
Credential:
Phone: 615-465-7488