Healthcare Provider Details
I. General information
NPI: 1316075419
Provider Name (Legal Business Name): ST. JOSEPH'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/01/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2010 ADAMS AVE
SCRANTON PA
18509-1508
US
IV. Provider business mailing address
2010 ADAMS AVE
SCRANTON PA
18509-1508
US
V. Phone/Fax
- Phone: 570-342-8379
- Fax: 570-963-1286
- Phone: 570-342-8379
- Fax: 570-963-1286
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251C00000X |
| Taxonomy | Developmentally Disabled Services Day Training Agency |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225800000X |
| Taxonomy | Recreation Therapist |
| License Number | |
| License Number State | PA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225A00000X |
| Taxonomy | Music Therapist |
| License Number | |
| License Number State | PA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225X00000X |
| Taxonomy | Occupational Therapist |
| License Number | |
| License Number State | PA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | PA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251E00000X |
| Taxonomy | Home Health Agency |
| License Number | |
| License Number State | PA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 320900000X |
| Taxonomy | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| License Number | |
| License Number State | PA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 385HR2060X |
| Taxonomy | Child Intellectual and/or Developmental Disabilities Respite Care |
| License Number | |
| License Number State | PA |
| # 10 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 315P00000X |
| Taxonomy | Intellectual Disabilities Intermediate Care Facility |
| License Number | |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1000013880031 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 2 | |
| Identifier | 1000013880061 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 1000013880038 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 4 | |
| Identifier | 1000013880054 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 5 | |
| Identifier | 1000013880055 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 6 | |
| Identifier | 1576764PT |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK BLUE SHIELD |
| # 7 | |
| Identifier | 1000013880034 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 8 | |
| Identifier | 1000013880040 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 9 | |
| Identifier | 1000013880046 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 10 | |
| Identifier | 1000013880047 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 11 | |
| Identifier | 1000013880048 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 12 | |
| Identifier | 1576770ST |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK BLUE SHIELD |
| # 13 | |
| Identifier | 1000013880001 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 14 | |
| Identifier | 1000013880049 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 15 | |
| Identifier | 1000013880050 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 16 | |
| Identifier | 1000013880056 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 17 | |
| Identifier | 1000013880058 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 18 | |
| Identifier | 1000013880063 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 19 | |
| Identifier | 1000013880057 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 20 | |
| Identifier | 1000013880059 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
VIII. Authorized Official
Name:
ROBERT
GORDON
Title or Position: VICE PRESIDENT CFO
Credential:
Phone: 570-963-1273
