Provider Demographics
NPI:1518058726
Name:DEPT OF MILITARY AFFAIRS, COMMONWEALTH OF PENNSYLVANIA
Entity Type:Organization
Organization Name:DEPT OF MILITARY AFFAIRS, COMMONWEALTH OF PENNSYLVANIA
Other - Org Name:HOLLIDAYSBURG VETERANS HOME
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:P. O. BOX 319
Mailing Address - Street 2:OLD RT. 220 AND MEADOWS INTERSECTION
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0319
Mailing Address - Country:US
Mailing Address - Phone:814-696-5201
Mailing Address - Fax:814-696-5346
Practice Address - Street 1:OLD RT. 220 AND MEADOWS INTERSECTION
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-0319
Practice Address - Country:US
Practice Address - Phone:814-696-5201
Practice Address - Fax:814-696-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3414022865M2000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA598982Medicare PIN