Provider Demographics
NPI:1982021697
Name:CELTIC HEALTHCARE OF E. MO, LLC
Entity Type:Organization
Organization Name:CELTIC HEALTHCARE OF E. MO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURCHIANTI
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:724-720-1205
Mailing Address - Street 1:150 SCHARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1653 LARKIN WILLIAMS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2415
Practice Address - Country:US
Practice Address - Phone:800-358-8227
Practice Address - Fax:724-742-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO714-11HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-7567Medicare PIN