Basic Information
| Provider Information | |||||||||
| NPI: | 1043697212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | K & K HEALTH CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREEN VALLEY SKILLED NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 MOLTKE AVE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185052886 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 TAYLORSVILLE MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | PITMAN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179649104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706440489 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2015 | ||||||||
| LastUpdateDate: | 04/27/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5709692188 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 061502 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.