Provider Demographics
NPI:1417109315
Name:MAYLATH VALLEY HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:MAYLATH VALLEY HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYLATH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:570-708-2929
Mailing Address - Street 1:750 STATE ROUTE 93
Mailing Address - Street 2:PO BOX 103
Mailing Address - City:SYBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18251-0103
Mailing Address - Country:US
Mailing Address - Phone:570-708-2929
Mailing Address - Fax:
Practice Address - Street 1:750 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:SYBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18251-0103
Practice Address - Country:US
Practice Address - Phone:570-708-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023078050001Medicaid
PA1023078050001Medicaid