Organization
SHARED SUPPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA E PRATT (FISCAL DIRECTOR)
(570) 286-4982
Entity
Organization
Contact information
Practice address
2328 N BROAD ST, COLMAR, PA 18915-9725
(570) 286-4982
(570) 286-4984
Mailing address
2328 N BROAD ST, COLMAR, PA 18915-9725
(570) 286-4982
(570) 286-4984
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
251K00000X
Public Health or Welfare Agency
APPLIED FOR
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101490123
—
PA
Enumeration date
01/11/2013
Last updated
04/13/2017
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