Healthcare Provider Details

I. General information

NPI: 1568401743
Provider Name (Legal Business Name): DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GRAMPIAN BLVD 4 SOUTH
WILLIAMSPORT PA
17701-1909
US

IV. Provider business mailing address

1100 GRAMPIAN BLVD 4 SOUTH
WILLIAMSPORT PA
17701-1909
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7690
  • Fax: 570-320-7898
Mailing address:
  • Phone: 570-320-7690
  • Fax: 570-320-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number151399
License Number StatePA

VIII. Authorized Official

Name: MS. PATRICIA MCGEE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: RN
Phone: 570-320-7690