=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194725861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY HOSPITAL OF NANTICOKE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 W WASHINGTON ST
-----------------------------------------------------
City | NANTICOKE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18634-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-348-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2040
-----------------------------------------------------
City | SCRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18501-2040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-348-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. STEVE H FRANKO III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-348-7074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number | 141401
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------