Provider Demographics
NPI:1073263810
Name:GRISWOLD INTERNATIONAL CARE OF POCONOS PA, LLC
Entity Type:Organization
Organization Name:GRISWOLD INTERNATIONAL CARE OF POCONOS PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-424-7678
Mailing Address - Street 1:78 S COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2852
Mailing Address - Country:US
Mailing Address - Phone:570-424-7678
Mailing Address - Fax:570-424-7679
Practice Address - Street 1:510 TOWNSHIP LINE RD STE 210
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2721
Practice Address - Country:US
Practice Address - Phone:215-437-0372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRISWOLD INTERNATIONAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14723601OtherHOME CARE AGENCY FACILITY