Healthcare Provider Details

I. General information

NPI: 1013074269
Provider Name (Legal Business Name): SCRANTON HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 MCCARTHY ST
SCRANTON PA
18505-3017
US

IV. Provider business mailing address

2933 MCCARTHY ST
SCRANTON PA
18505-3017
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-6676
  • Fax: 570-341-6678
Mailing address:
  • Phone: 570-341-6676
  • Fax: 570-341-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number17720201
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1011919840001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL KELLY
Title or Position: MANAGING MEMBER
Credential: MBA, NHA
Phone: 570-341-6676