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NPI Code Detail

MEDICARE: DAVIS NURSING HOME, INC.

MEDICARE: DAVIS NURSING HOME, INC.
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
1314000000XSkilled Nursing Facility040802PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760483440
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVIS NURSING HOME, INC.
Provider Business Mailing Address
First Line : 185 S MOUNTAIN BLVD
Second Line :
City : MOUNTAIN TOP
State : PA
Zip : 18707-1921
Country : US
Telephone Number : 570-474-6377
Fax Number : 570-474-6712
Provider Business Practice Location Address
First Line : 185 S MOUNTAIN BLVD
Second Line :
City : MOUNTAIN TOP
State : PA
Zip : 18707-1921
Country : US
Telephone Number : 570-474-6377
Fax Number : 570-474-6712
Authorized Official
Title or Position : CEO
Name : MS. CHARLENE DAVIS
Credential : NHA
Telephone Number : 570-474-6377
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/22/2020

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