Basic Information
| Provider Information | |||||||||
| NPI: | 1023141306 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SUSQUEHANNA HOME CARE & HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 GRAMPIAN BLVD | ||||||||
| Address2: | 4 SOUTH | ||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177011909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703207690 | ||||||||
| FaxNumber: | 5703207898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 GRAMPIAN BLVD | ||||||||
| Address2: | 4 SOUTH | ||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177011909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703207690 | ||||||||
| FaxNumber: | 5703207898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SANTANGELO | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT CFO | ||||||||
| AuthorizedOfficialTelephone: | 5703213171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 700605 | PA | N | Agencies | Nursing Care | 163W00000X | 700605 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.