Healthcare Provider Details

I. General information

NPI: 1861469355
Provider Name (Legal Business Name): KELLER ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HAP ARNOLD BLVD HEALTH CLINIC
TOBYHANNA PA
18466-5002
US

IV. Provider business mailing address

11 HAP ARNOLD BLVD HEALTH CLINIC
TOBYHANNA PA
18466-5002
US

V. Phone/Fax

Practice location:
  • Phone: 570-895-6242
  • Fax: 570-895-6783
Mailing address:
  • Phone: 570-895-6242
  • Fax: 570-895-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberMD013443E
License Number StatePA

VIII. Authorized Official

Name: DR. ITALO M BASTIANELLI
Title or Position: DCCS
Credential: MD
Phone: 854-938-6940