Provider Demographics
NPI:1326337528
Name:NANTICOKE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:NANTICOKE HOSPITAL COMPANY LLC
Other - Org Name:SPECIAL CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH REP / DIR BUS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7488
Mailing Address - Street 1:128 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3113
Mailing Address - Country:US
Mailing Address - Phone:570-348-7100
Mailing Address - Fax:570-348-7696
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3113
Practice Address - Country:US
Practice Address - Phone:570-348-7100
Practice Address - Fax:570-348-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282E00000X
PA141401284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA392025Medicare Oscar/Certification