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General NPI Number Information
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NPI Number | 1669899274
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Entity Type | Organization
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Legal Business Name | CELTIC PRIVATE CARE OF IL & MO, LLC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 1809 W MCCORD ST
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City | CENTRALIA
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State | IL
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Zip | 62801-5838
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Country | US
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Telephone | 618-545-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SCHARBERRY LN
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City | MARS
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State | PA
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Zip | 16046-2430
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Country | US
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Telephone | 800-355-8894
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARNOLD E BURCHIANTI II
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Credential |
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Telephone | 724-720-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000188
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License Number State | IL
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