Organization
OP HAZLETON II, LLC
Active
Other names
The Pavilion at St. Luke Village
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH CONTE (CHIEF OPERATING OFFICER)
(407) 571-1550
Entity
Organization
Contact information
Practice address
1000 STACIE DR, HAZLETON, PA 18201-5690
(570) 453-5100
(570) 453-5106
Mailing address
800 CONCOURSE PKWY S, SUITE 200, MAITLAND, FL 32751-6148
(407) 571-1550
(407) 571-1599
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
455202
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012274730001
—
PA
Enumeration date
06/08/2006
Last updated
08/22/2020
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