Provider Demographics
NPI:1043809577
Name:DELAWARE VALLEY SKILLED NURSING OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:DELAWARE VALLEY SKILLED NURSING OPERATING COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-969-2188
Mailing Address - Street 1:401 MOLTKE AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-2057
Practice Address - Country:US
Practice Address - Phone:570-491-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility