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NPI Code Detail

MEDICARE: LTC ASSOCIATES LLC

MEDICARE: LTC ASSOCIATES 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
1314000000XSkilled Nursing Facility061202PA

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 : 1770745598
Entity Type Code : Organization
Provider Name (Legal Business Name) : LTC ASSOCIATES LLC
Provider Business Mailing Address
First Line : 915 DELAWARE ST
Second Line :
City : FOREST CITY
State : PA
Zip : 18421-1005
Country : US
Telephone Number : 570-785-3005
Fax Number : 570-785-3005
Provider Business Practice Location Address
First Line : 915 DELAWARE ST
Second Line :
City : FOREST CITY
State : PA
Zip : 18421-1005
Country : US
Telephone Number : 570-785-3005
Fax Number : 570-785-3005
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : DREW SPARKS
Credential :
Telephone Number : 570-785-3005
Provider Enumeration Date : 07/02/2008
Last Update Date : 02/24/2009

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1417172685 — BRANDI ANN SCHIAVONE MS OTRL
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1891911798 — MRS. CHRISTINE SZYMASZEK
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Directions to “LTC ASSOCIATES LLC ” Practice Location

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