Healthcare Provider Details

I. General information

NPI: 1023141306
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: 03/14/2007
Last Update Date: 04/06/2009
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 TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number700605
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number700605
License Number StatePA

VIII. Authorized Official

Name: MR. CHARLES SANTANGELO
Title or Position: EXECUTIVE VICE PRESIDENT CFO
Credential:
Phone: 570-321-3171