Basic Information
| Provider Information | |||||||||
| NPI: | 1518049899 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY CREST NURSING, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALLEY CREST NURSING & REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 DRYDEN ROAD, SUITE 2000 | ||||||||
| Address2: | |||||||||
| City: | DRESHER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190251048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154417700 | ||||||||
| FaxNumber: | 2154414255 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 EAST END BLVD. PLAINS TWP. | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187111011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708261011 | ||||||||
| FaxNumber: | 5708251211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LICARI | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154417700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 220102 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.