Provider Demographics
NPI:1013074269
Name:SCRANTON HEALTH CARE CENTER
Entity Type:Organization
Organization Name:SCRANTON HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, NHA
Authorized Official - Phone:570-341-6676
Mailing Address - Street 1:2933 MCCARTHY ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3017
Mailing Address - Country:US
Mailing Address - Phone:570-341-6676
Mailing Address - Fax:570-341-6678
Practice Address - Street 1:2933 MCCARTHY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3017
Practice Address - Country:US
Practice Address - Phone:570-341-6676
Practice Address - Fax:570-341-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17720201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011919840001Medicaid
PA1011919840001Medicaid