Provider Demographics
NPI:1619062858
Name:LEEDS HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:LEEDS HEALTH CARE SERVICES INC
Other - Org Name:NOTTINGHAM VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-473-8366
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:58 NEITZ ROAD
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-0032
Mailing Address - Country:US
Mailing Address - Phone:570-473-8366
Mailing Address - Fax:570-473-9752
Practice Address - Street 1:58 NEITZ ROAD
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-0032
Practice Address - Country:US
Practice Address - Phone:570-473-8366
Practice Address - Fax:570-473-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
PA401002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001975195002Medicaid
PA001975195002Medicaid