Provider Demographics
NPI:1255488904
Name:COLUMBIA MONTOUR HOME HEALTH SERVICES VNA, INC.
Entity Type:Organization
Organization Name:COLUMBIA MONTOUR HOME HEALTH SERVICES VNA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-1723
Mailing Address - Street 1:410 GLENN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1200
Mailing Address - Country:US
Mailing Address - Phone:570-784-1723
Mailing Address - Fax:570-784-8512
Practice Address - Street 1:107 S MARKET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4824
Practice Address - Country:US
Practice Address - Phone:570-759-3970
Practice Address - Fax:570-759-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA708605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007466820006Medicaid