NPIMap

Organization Active NPI

Mid-Valley Health Care Center LLC

  • Skilled Nursing Facility
  • Peckville, PA
National Provider Identifier
1225024003
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
027502 Issued in PA
Legal business name
MID-VALLEY HEALTH CARE CENTER LLC
Doing business as
Mid-Valley Health Care Center
Practice address
81 Sturges Rd
Peckville, PA 18452-1302
Phone
(570) 383-7320
Fax
(570) 383-5152
NPI assigned
Sep 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Authorized official

Name
Mr. Michael P Kelly
Title
Managing Member
Phone
(570) 969-2188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 027502 PA Primary

Addresses

Primary practice location

81 Sturges Rd
Peckville, PA 18452-1302

Mailing address

401 Moltke Ave
Suite 100
Scranton, PA 18505-2886
Phone (570) 969-2188

Other identifiers 1

IdentifierTypeStateIssuer
102794713-0001MedicaidPA

Other names 1

  • Mid-Valley Health Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mid Valley Health Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1225024003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MOLTKE AVE",
            "address_2": "SUITE 100",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185052886",
            "telephone_number": "570-969-2188",
            "fax_number": "570-969-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 STURGES RD",
            "city": "PECKVILLE",
            "state": "PA",
            "postal_code": "184521302",
            "telephone_number": "570-383-7320",
            "fax_number": "570-383-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "570-969-2188",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "027502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102794713-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-Valley Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peckville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.