Organization
TRI-COUNTY NURSING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA DIANE REDMOND (OWNER)
(814) 265-0011
Entity
Organization
Contact information
Practice address
426 MAIN ST, BROCKWAY, PA 15824-1325
(814) 265-0011
(814) 265-0015
Mailing address
426 MAIN ST, BROCKWAY, PA 15824-1325
(814) 265-0011
(814) 265-0015
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
03590501
PA
163WP0200X
Pediatric Registered Nurse
Primary
03590501
PA
164W00000X
Licensed Practical Nurse
03590501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023846350001
—
PA
01
—
3845616
ENTITY ID
PA
01
—
398108
CMS CERTIFICATION #
PA
Enumeration date
11/23/2016
Last updated
11/23/2016
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