Healthcare Provider Details

I. General information

NPI: 1730321837
Provider Name (Legal Business Name): WILKES BARRE SKILLED NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E NORTHAMPTON ST
WILKES BARRE PA
18701-3035
US

IV. Provider business mailing address

80 E NORTHAMPTON ST
WILKES BARRE PA
18701-3035
US

V. Phone/Fax

Practice location:
  • Phone: 570-826-1031
  • Fax:
Mailing address:
  • Phone: 570-826-1031
  • 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: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466