Basic Information
| Provider Information | |||||||||
| NPI: | 1154303311 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSPREY RIDGE HEALTHCARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 N SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184071833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702821099 | ||||||||
| FaxNumber: | 5702825380 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 N SCOTT ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184071833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702821099 | ||||||||
| FaxNumber: | 5702825380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 10/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | SALKO | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5702821099 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 067702 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0015819780002 | 05 | PA | MEDICAID |