Organization
ANGEL HEARTS PEDIATRIC CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKY J LONG CEO (AUTHORIZED OFIICIAL)
(570) 875-9094
Entity
Organization
Contact information
Practice address
44 E INDEPENDENCE ST, SHAMOKIN, PA 17872-6804
(570) 648-6100
(570) 648-6104
Mailing address
44 E INDEPENDENCE ST, SHAMOKIN, PA 17872-6804
(570) 648-6100
(570) 648-6104
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
05640501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029803430001
—
PA
Enumeration date
01/05/2015
Last updated
07/01/2015
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