Healthcare Provider Details

I. General information

NPI: 1659661684
Provider Name (Legal Business Name): SCRANTON HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

IV. Provider business mailing address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-0725
  • Fax: 570-340-5484
Mailing address:
  • Phone: 570-961-0725
  • Fax: 570-340-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1659373215
Identifier TypeOTHER
Identifier State
Identifier IssuerOLD NPI
# 3
Identifier1013990704
Identifier TypeOTHER
Identifier State
Identifier IssuerOLD NPI
# 4
Identifier1184626988
Identifier TypeOTHER
Identifier State
Identifier IssuerOLD NPI

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIR. BUSINESS OFFICE SUPPORT
Credential:
Phone: 615-465-7466