Healthcare Provider Details

I. General information

NPI: 1528061785
Provider Name (Legal Business Name): MOUNTAIN VIEW NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 STAFFORD AVE
SCRANTON PA
18505-3686
US

IV. Provider business mailing address

2309 STAFFORD AVE
SCRANTON PA
18505-3686
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-0050
  • Fax: 570-341-0051
Mailing address:
  • Phone: 570-341-0050
  • Fax: 570-341-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number053602
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0013905550001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. ROBERT EDWARD MCQUILLAN
Title or Position: ASSOC VICE PRESIDENT
Credential:
Phone: 570-214-9790