Organization
DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Active
Parent organization
DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Other names
Divine Providence Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE PROVIDENCE HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
Authorized official
MR. CHARLES J. SANTANGELO CPA FHFMA (EXECUTIVE VP CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
21 SUSQUEHANNA VALLEY MALL DRIVE, SUITE D, SELINSGROVE, PA 17870
(570) 374-5454
(570) 326-8601
Mailing address
1205 GRAMPIAN BLVD, 2ND FLOOR, WILLIAMSPORT, PA 17701-1978
(570) 326-8676
(570) 326-8601
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
041001
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000070
AMERIHEALTH ADMINSTR PIN
PA
05
—
1007563750011
—
PA
01
—
1066310
KEYSTONE MERCY HEALTH PIN
PA
01
—
20012697
AMERIHEALTH HMO AMER PIN
PA
01
—
393510
BLUE CROSS PIN
PA
01
—
394048
HEALTH AMERICA PIN
PA
01
—
396871
BLACK LUNG PROGRAM PIN
PA
01
—
70159
GEISINGER HEALTH PLAN PIN
PA
01
—
816867
FIRST PRIORITY HEALTH PIN
PA
Enumeration date
09/05/2006
Last updated
04/20/2008
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