Provider Demographics
NPI:1073560553
Name:GEISINGER COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:GEISINGER COMMUNITY HEALTH SERVICES
Other - Org Name:LIFE GEISINGER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-214-9806
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-214-9790
Mailing Address - Fax:570-214-9791
Practice Address - Street 1:592 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2102
Practice Address - Country:US
Practice Address - Phone:570-808-4780
Practice Address - Fax:570-808-4781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEISINGER COMMUNITY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-28
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251T00000X251T00000X
251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000038000038Medicaid
PA1000038000028Medicaid
PA1000038000035Medicaid