MEDICARE: RELIANT BUTLER HOLDINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1427315357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT BUTLER HOLDINGS LLC

Provider Business Mailing Address
First Line	:	3601 ISLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-3228
Country	:	US
Telephone Number	:	215-558-3700
Fax Number	:	215-558-3701

Provider Business Practice Location Address
First Line	:	463 N HUNTER HWY
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-2129
Country	:	US
Telephone Number	:	570-788-4175
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. NATHAN NILES
Credential	:	CPA
Telephone Number	:	215-558-3700

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	12/23/2013

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