Provider Demographics
NPI:1255328191
Name:COMMUNITY NURSING SERVICE OF CLINTON COUNTY INC
Entity Type:Organization
Organization Name:COMMUNITY NURSING SERVICE OF CLINTON COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:M ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:570-748-8511
Mailing Address - Street 1:124 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1634
Mailing Address - Country:US
Mailing Address - Phone:570-748-8511
Mailing Address - Fax:570-748-3599
Practice Address - Street 1:124 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1634
Practice Address - Country:US
Practice Address - Phone:570-748-8511
Practice Address - Fax:570-748-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397029Medicare ID - Type Unspecified