Provider Demographics
NPI:1154318871
Name:COUNTY OF SCHUYLKILL
Entity Type:Organization
Organization Name:COUNTY OF SCHUYLKILL
Other - Org Name:SCHUYLKILL COUNTY NURSING HOME - REST HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, NHA
Authorized Official - Phone:570-385-1185
Mailing Address - Street 1:401 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-2212
Mailing Address - Country:US
Mailing Address - Phone:570-385-0331
Mailing Address - Fax:570-385-1007
Practice Address - Street 1:401 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-2212
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:570-385-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA701002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000073180006Medicaid
PA1000073180006Medicaid