Provider Demographics
NPI:1073587796
Name:SUSQUEHANNA VALLEY HOME HEALTH CARE
Entity Type:Organization
Organization Name:SUSQUEHANNA VALLEY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:POLAKOWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN MSOM
Authorized Official - Phone:570-271-0933
Mailing Address - Street 1:273 GOTSCHAL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821
Mailing Address - Country:US
Mailing Address - Phone:570-271-0933
Mailing Address - Fax:570-271-2830
Practice Address - Street 1:273 GOTSCHAL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821
Practice Address - Country:US
Practice Address - Phone:570-271-0933
Practice Address - Fax:570-271-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02190501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009435290001Medicaid
PA1009435290001Medicaid