Provider Demographics
NPI:1235137472
Name:JEWISH HOME OF EASTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:JEWISH HOME OF EASTERN PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SANDHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-344-6177
Mailing Address - Street 1:1101 VINE ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2126
Mailing Address - Country:US
Mailing Address - Phone:570-344-6177
Mailing Address - Fax:570-344-9610
Practice Address - Street 1:1101 VINE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2126
Practice Address - Country:US
Practice Address - Phone:570-344-6177
Practice Address - Fax:570-344-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA360402314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007472840001Medicaid
PA0007472840001Medicaid
395103Medicare Oscar/Certification