Provider Demographics
NPI:1497734925
Name:DEPARTMENT OF MILITARY COMMONWEALTH OF PENNSYLVANIA
Entity Type:Organization
Organization Name:DEPARTMENT OF MILITARY COMMONWEALTH OF PENNSYLVANIA
Other - Org Name:GINO J. MERLI VETERANS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL SERVICES ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-242-7789
Mailing Address - Street 1:401 PENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-961-4353
Mailing Address - Fax:570-961-4405
Practice Address - Street 1:401 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-961-4353
Practice Address - Fax:570-961-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2865M2000X, 314000000X
PAHP4183791313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA762526Medicare PIN