Provider Demographics
NPI:1851781249
Name:OAK HRC BROAD MOUNTAIN LLC
Entity Type:Organization
Organization Name:OAK HRC BROAD MOUNTAIN LLC
Other - Org Name:BROAD MOUNTAIN HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-346-6454
Mailing Address - Street 1:500 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2018
Mailing Address - Country:US
Mailing Address - Phone:570-874-0696
Mailing Address - Fax:
Practice Address - Street 1:500 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2018
Practice Address - Country:US
Practice Address - Phone:570-874-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK HEALTH AND REHABILITATION CENTERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
395286Medicare Oscar/Certification