Provider Demographics
NPI:1982718839
Name:CHS BERWICK HOSPITAL CENTER
Entity Type:Organization
Organization Name:CHS BERWICK HOSPITAL CENTER
Other - Org Name:BERWICK HOSPITAL CENTER HOME HEALTH PRIVATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-759-5020
Mailing Address - Street 1:120 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3726
Mailing Address - Country:US
Mailing Address - Phone:570-759-7892
Mailing Address - Fax:570-752-5929
Practice Address - Street 1:120 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3726
Practice Address - Country:US
Practice Address - Phone:570-759-7892
Practice Address - Fax:570-752-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA01850500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007562590007Medicaid
PA1007562590007Medicaid