Provider Demographics
NPI:1154303311
Name:OSPREY RIDGE HEALTHCARE CENTER
Entity Type:Organization
Organization Name:OSPREY RIDGE HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-282-1099
Mailing Address - Street 1:45 N SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1833
Mailing Address - Country:US
Mailing Address - Phone:570-282-1099
Mailing Address - Fax:570-282-5380
Practice Address - Street 1:45 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1833
Practice Address - Country:US
Practice Address - Phone:570-282-1099
Practice Address - Fax:570-282-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA067702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015819780002Medicaid
PA395984Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER