Healthcare Provider Details

I. General information

NPI: 1275890618
Provider Name (Legal Business Name): RELIANT PALMYRA HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N RAILROAD ST
PALMYRA PA
17078-1328
US

IV. Provider business mailing address

3601 ISLAND AVE
PHILADELPHIA PA
19153-3228
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-3011
  • Fax:
Mailing address:
  • Phone: 215-558-3700
  • Fax: 215-558-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARC MYZAL
Title or Position: COO
Credential:
Phone: 215-558-3700