1194798652 NPI number — VALLEY CREST NURSING , L.P.

Table of content: (NPI 1194798652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194798652 NPI number — VALLEY CREST NURSING , L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CREST NURSING , L.P.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY CREST NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194798652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 GIBRALTAR ROAD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
HORSHAM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19044-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-441-7700
Provider Business Mailing Address Fax Number:
215-441-4255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 EAST END BLVD. PLAINS TWP.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18711-0575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-1011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LICARI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT OF GENERAL PARTNER
Authorized Official Telephone Number:
215-441-7700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  220102 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1014868460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".