Healthcare Provider Details

I. General information

NPI: 1497734925
Provider Name (Legal Business Name): DEPARTMENT OF MILITARY COMMONWEALTH OF PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PENN AVE
SCRANTON PA
18503
US

IV. Provider business mailing address

401 PENN AVENUE
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-961-4353
  • Fax: 570-961-4400
Mailing address:
  • Phone: 570-961-4353
  • Fax: 570-961-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberHP4183791
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. THOMAS REED JR.
Title or Position: FISCAL SERVICES ADMINISTRATOR
Credential:
Phone: 814-242-7789