Healthcare Provider Details

I. General information

NPI: 1407885569
Provider Name (Legal Business Name): BRADFORD COUNTY COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 ROUTE 6
TROY PA
16947-9308
US

IV. Provider business mailing address

15900 ROUTE 6
TROY PA
16947-9308
US

V. Phone/Fax

Practice location:
  • Phone: 570-297-4111
  • Fax: 570-297-0717
Mailing address:
  • Phone: 570-297-4111
  • Fax: 570-297-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number022302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StatePA

VIII. Authorized Official

Name: LOUANN SIMPSON
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 570-297-4111