Basic Information
| Provider Information | |||||||||
| NPI: | 1508116062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RELIANT OSPREY HOLDINGS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OSPREY RIDGE HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 ISLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191533228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155583700 | ||||||||
| FaxNumber: | 2155583701 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 NORTH SCOTT STREET | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184071833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702821099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | THERESE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2155583700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.