Healthcare Provider Details

I. General information

NPI: 1457166290
Provider Name (Legal Business Name): TUNKHANNOCK REHABILITATION & HEALTH CARE CENTER OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 WEST ST
TUNKHANNOCK PA
18657-1405
US

IV. Provider business mailing address

401 MOLTKE AVE STE 100
SCRANTON PA
18505-2886
US

V. Phone/Fax

Practice location:
  • Phone: 570-996-6777
  • Fax:
Mailing address:
  • Phone: 570-969-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MICHAEL KELLY
Title or Position: MANAGING MEMBER/OWNER
Credential:
Phone: 570-575-0744