Provider Demographics
NPI:1205839040
Name:ST. LUKE'S MINERS MEMORIAL HOME CARE
Entity Type:Organization
Organization Name:ST. LUKE'S MINERS MEMORIAL HOME CARE
Other - Org Name:ST. LUKE'S MINERS MEMORIAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HALDEMAN-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN COS-C
Authorized Official - Phone:570-952-8219
Mailing Address - Street 1:801 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-2210
Mailing Address - Country:US
Mailing Address - Phone:570-952-8219
Mailing Address - Fax:570-952-8119
Practice Address - Street 1:801 E BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-2210
Practice Address - Country:US
Practice Address - Phone:570-952-8219
Practice Address - Fax:570-952-8119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARBON SCHUYLKILL COMMUNITY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA397575251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397575Medicare Oscar/Certification