Provider Demographics
NPI:1740570159
Name:NANTICOKE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:NANTICOKE HOSPITAL COMPANY LLC
Other - Org Name:SPECIAL CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL / DIR BUS OFFICE SUP
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:128 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3113
Mailing Address - Country:US
Mailing Address - Phone:570-836-6236
Mailing Address - Fax:
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3113
Practice Address - Country:US
Practice Address - Phone:570-836-6236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTICOKE HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-19
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
39S025Medicare Oscar/Certification