Provider Demographics
NPI:1144421488
Name:SWINGHOLM, CHARLES MARVIN (RN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MARVIN
Last Name:SWINGHOLM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY-MARGARET
Other - Middle Name:WALTZ
Other - Last Name:BJORKSTEDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17087-0146
Mailing Address - Country:US
Mailing Address - Phone:717-866-6278
Mailing Address - Fax:
Practice Address - Street 1:LEBANON TREATMENT CENTER OF CRC HEALTH GROUP
Practice Address - Street 2:3030 CHESTNUT STREET
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-0000
Practice Address - Country:US
Practice Address - Phone:717-273-8000
Practice Address - Fax:717-273-8244
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN188454L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse