Provider Demographics
NPI:1679501662
Name:WVHCS-HOSPITAL
Entity Type:Organization
Organization Name:WVHCS-HOSPITAL
Other - Org Name:WVHCS-HOSPITAL TRANSITIONAL CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-552-3023
Mailing Address - Street 1:575 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18764-0999
Mailing Address - Country:US
Mailing Address - Phone:570-829-8111
Mailing Address - Fax:570-552-3030
Practice Address - Street 1:575 N RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18764-0999
Practice Address - Country:US
Practice Address - Phone:570-829-8111
Practice Address - Fax:570-552-3030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WVHCS-HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6491500OtherAETNA
PA812545OtherFIRST PRIORITY HEALTH TCU
PAIY0034OtherHEALTHNET
PA0299OtherFREEDOM BLUE
PAIY0034OtherHEALTHNET