Healthcare Provider Details

I. General information

NPI: 1861521627
Provider Name (Legal Business Name): SUSQUEHANNA VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GRAMPIAN BLVD SUSQUEHANNA HOME MEDICAL PO
WILLIAMSPORT PA
17701-1900
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD SUSQUEHANNA HOME MEDICAL PO
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7660
  • Fax: 570-320-7659
Mailing address:
  • Phone: 570-320-7660
  • Fax: 570-320-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPP413352L
License Number StatePA

VIII. Authorized Official

Name: MR. CHARLES SANTANGELO
Title or Position: CFO
Credential:
Phone: 570-320-7661