Provider Demographics
NPI:1134103047
Name:LITTLE FLOWER MANOR
Entity Type:Organization
Organization Name:LITTLE FLOWER MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:B KENNY
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA; MST
Authorized Official - Phone:570-823-6131
Mailing Address - Street 1:200 S MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6221
Mailing Address - Country:US
Mailing Address - Phone:570-823-6131
Mailing Address - Fax:570-823-6385
Practice Address - Street 1:200 S MEADE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6221
Practice Address - Country:US
Practice Address - Phone:570-823-6131
Practice Address - Fax:570-823-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007513020001Medicaid
PA0007513020001Medicaid