Organization
SHARED SUPPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA E PRATT (FISCAL DIRECTOR)
(570) 286-4982
Entity
Organization
Contact information
Practice address
218 BRIDGE AVE, SUNBURY, PA 17801-1006
(570) 286-4982
(570) 286-4984
Mailing address
218 BRIDGE AVE, SUNBURY, PA 17801-1006
(570) 286-4982
(570) 286-4984
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
251K00000X
Public Health or Welfare Agency
Primary
329450
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101490123
—
PA
Enumeration date
04/04/2012
Last updated
04/12/2017
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