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General NPI Number Information
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NPI Number | 1861521627
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VENTURES, INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 GRAMPIAN BLVD SUSQUEHANNA HOME MEDICAL PO
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone | 570-320-7660
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Fax | 570-320-7659
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD SUSQUEHANNA HOME MEDICAL PO
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone | 570-320-7660
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Fax | 570-320-7659
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Authorized Official
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Title or Position | CFO
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Name | MR. CHARLES SANTANGELO
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Credential |
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Telephone | 570-320-7661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PP413352L
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License Number State | PA
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