Healthcare Provider Details

I. General information

NPI: 1437128139
Provider Name (Legal Business Name): PENNSYLVANIA LTC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LYNWOOD AVE
SCRANTON PA
18505-2868
US

IV. Provider business mailing address

100 LINWOOD AVE
SCRANTON PA
18505-2868
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7381
  • Fax: 570-346-3761
Mailing address:
  • Phone: 570-346-7381
  • Fax: 570-346-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number394502
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number394502
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number394502
License Number StatePA

VIII. Authorized Official

Name: JANE DROPESKEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 610-925-4231