Provider Demographics
NPI:1609873959
Name:ALLIED SERVICES PERSONAL CARE, INC
Entity Type:Organization
Organization Name:ALLIED SERVICES PERSONAL CARE, INC
Other - Org Name:ALLIED SERVICES TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT VP
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHENDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-348-1314
Mailing Address - Street 1:100 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2612
Mailing Address - Country:US
Mailing Address - Phone:570-341-4659
Mailing Address - Fax:570-341-4372
Practice Address - Street 1:100 TERRACE LN
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2612
Practice Address - Country:US
Practice Address - Phone:570-341-4659
Practice Address - Fax:570-341-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200250310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility