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Organization
1711 EAST BROAD STREET OPCO LLC
Active
Organization
1711 EAST BROAD STREET OPCO LLC
Active
Other names
The Manor at St. Luke Village
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY HOBACK (MANAGER)
(770) 698-9040
Entity
Organization
Contact information
Practice address
1711 E BROAD ST, HAZLETON, PA 18201-5691
(570) 453-5100
(570) 453-5138
Mailing address
1711 E BROAD ST, HAZLETON, PA 18201-5691
(570) 453-5100
(570) 453-5138
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Enumeration date
12/24/2024
Last updated
03/10/2025
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