Healthcare Provider Details

I. General information

NPI: 1417929878
Provider Name (Legal Business Name): SUNBURY HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N 11TH ST
SUNBURY PA
17801-1611
US

IV. Provider business mailing address

PO BOX 504236
SAINT LOUIS MO
63150-4236
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number930070
License Number StatePA

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR BUSINESS SUPPORT
Credential:
Phone: 615-465-7466