Angel Hearts Pediatric Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

05640501 Issued in PA

Legal business name

ANGEL HEARTS PEDIATRIC CARE, LLC

Practice address

44 E Independence St
Shamokin, PA 17872-6804

Phone

(570) 648-6100

Fax

(570) 648-6104

NPI assigned

Jan 5, 2015

Last updated

Jul 1, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ricky J Long, CEO

Title

Authorized Ofiicial

Phone

(570) 875-9094

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1063800712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 E INDEPENDENCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178726804",
            "telephone_number": "570-648-6100",
            "fax_number": "570-648-6104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 E INDEPENDENCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178726804",
            "telephone_number": "570-648-6100",
            "fax_number": "570-648-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL HEARTS PEDIATRIC CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFIICIAL",
        "authorized_official_telephone_number": "570-875-9094",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "05640501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029803430001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Shamokin, PA
• Providers in Shamokin, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.