Provider Demographics
NPI:1801336458
Name:SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-344-3517
Mailing Address - Street 1:959 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-3023
Mailing Address - Country:US
Mailing Address - Phone:570-344-3517
Mailing Address - Fax:570-344-9683
Practice Address - Street 1:425 ALDER ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-4126
Practice Address - Country:US
Practice Address - Phone:570-955-5524
Practice Address - Fax:570-354-2113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-01
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)