NPIMap

Organization Active NPI

Valley Crest Nursing Home (Luzerne County)

  • Skilled Nursing Facility
  • Wilkes Barre, PA
National Provider Identifier
1669463949
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
220102 Issued in PA
Legal business name
VALLEY CREST NURSING HOME (LUZERNE COUNTY)
Practice address
1551 E End Blvd
Wilkes Barre, PA 18711-0576
Phone
(570) 826-1011
Fax
(570) 825-1211
NPI assigned
Nov 4, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James Miller, NHA
Title
Administrator
Phone
(570) 826-1011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 220102 PA Primary

Addresses

Primary practice location

1551 E End Blvd
Wilkes Barre, PA 18711-0576

Mailing address

1551 E End Blvd
Wilkes Barre, PA 18711-0576
Phone (570) 826-1011

Other identifiers 1

IdentifierTypeStateIssuer
0752275MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Luzerne Wyoming Counties Mental Health Mental Retardation Program5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1551 E End Blvd
Wilkes Barre, PA 18711
Phone (570) 826-1011

NPI Registry JSON

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669463949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 E END BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110576",
            "telephone_number": "570-826-1011",
            "fax_number": "570-825-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 E END BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110576",
            "telephone_number": "570-826-1011",
            "fax_number": "570-825-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY CREST NURSING HOME (LUZERNE COUNTY)",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-826-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "220102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0752275",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.