Provider Demographics
NPI:1366448268
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:RN
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 1:410 GLENN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1200
Practice Address - Country:US
Practice Address - Phone:570-784-1723
Practice Address - Fax:570-784-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA708605251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397086OtherBLUE CROSS HOME HEALTH
PA1007466820007Medicaid
PA1643OtherBLUE SHIELD HOME HEALTH
PA1643OtherBLUE SHIELD HOME HEALTH