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General NPI Number Information
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NPI Number | 1508116062
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Entity Type | Organization
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Legal Business Name | RELIANT OSPREY HOLDINGS, LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 45 NORTH SCOTT STREET
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City | CARBONDALE
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State | PA
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Zip | 18407-1833
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Country | US
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Telephone | 570-282-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 ISLAND AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19153-3228
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Country | US
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Telephone | 215-558-3700
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Fax | 215-558-3701
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | THERESE JACKSON
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Credential |
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Telephone | 215-558-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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