Provider Demographics
NPI:1942763297
Name:ELLEN MEMORIAL, LLC
Entity Type:Organization
Organization Name:ELLEN MEMORIAL, LLC
Other - Org Name:ELLEN MEMORIAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-616-7215
Mailing Address - Street 1:23 ELLEN MEMORIAL LN
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4096
Mailing Address - Country:US
Mailing Address - Phone:570-253-5690
Mailing Address - Fax:
Practice Address - Street 1:23 ELLEN MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4096
Practice Address - Country:US
Practice Address - Phone:570-253-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility