Provider Demographics
NPI:1598162398
Name:OAK HRC MOUNTAIN LAUREL LLC
Entity Type:Organization
Organization Name:OAK HRC MOUNTAIN LAUREL LLC
Other - Org Name:MOUNTAIN LAUREL NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-346-6454
Mailing Address - Street 1:700 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3245
Mailing Address - Country:US
Mailing Address - Phone:814-765-7545
Mailing Address - Fax:
Practice Address - Street 1:700 LEONARD ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3245
Practice Address - Country:US
Practice Address - Phone:814-765-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK HEALTH AND REHABILITATION CENTERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
395331Medicare Oscar/Certification