Provider Demographics
NPI:1598787590
Name:UPMC MUNCY
Entity Type:Organization
Organization Name:UPMC MUNCY
Other - Org Name:SUSQUEHANNA HEALTH SKILLED NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-578-9592
Mailing Address - Street 1:600 GRANT STREET US STEEL TOWER
Mailing Address - Street 2:59TH FLOOR, C/O RENEE JOHNSON
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-2740
Mailing Address - Country:US
Mailing Address - Phone:412-623-6303
Mailing Address - Fax:412-623-6369
Practice Address - Street 1:215 E WATER ST
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8828
Practice Address - Country:US
Practice Address - Phone:570-546-4040
Practice Address - Fax:570-326-8601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC SUSQUEHANNA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA134302314000000X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000111OtherAMERIHEALTH ADMINSTR PIN
PA058074OtherFIRST PRIORITY HEALTH PIN
PA395571OtherHEALTH AMERICA PIN
PA20020966OtherAMERIHEALTH HMO AMER PIN
PA395571OtherBLUE CROSS PIN
PA391301OtherAETNA PIN
PA395571OtherBLACK LUNG PROGRAM PIN
PA1007607800001Medicaid
PA29430OtherGEISINGER HEALTH PLAN PIN
PA395571OtherBLUE CROSS PIN
PA2073300001Medicare NSC
PA058074OtherFIRST PRIORITY HEALTH PIN