Basic Information
| Provider Information | |||||||||
| NPI: | 1235478470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S MANOR AND PAVILION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 ADAMS STREET | ||||||||
| Address2: | |||||||||
| City: | FREELAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709569262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | FREELAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182242103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709569262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | GRINK | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5704531000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TE009178 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.