Provider Demographics
NPI:1235134446
Name:CARBON COUNTY
Entity Type:Organization
Organization Name:CARBON COUNTY
Other - Org Name:CARBON COUNTY NURSING HOME & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKISZ
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:570-427-8683
Mailing Address - Street 1:1000 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255-1530
Mailing Address - Country:US
Mailing Address - Phone:570-427-8683
Mailing Address - Fax:570-427-4988
Practice Address - Street 1:1000 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERLY
Practice Address - State:PA
Practice Address - Zip Code:18255-1530
Practice Address - Country:US
Practice Address - Phone:570-427-8683
Practice Address - Fax:570-427-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3326OtherRAILROAD MEDICARE
037720600OtherFEDERAL BLACK LUNG
PA1007600550014Medicaid
HO634394OtherMEDICARE PART B
CA3326OtherRAILROAD MEDICARE
HO634394OtherMEDICARE PART B