Provider Demographics
NPI:1063702074
Name:ST. LUKE'S VILLA
Entity type:Organization
Organization Name:ST. LUKE'S VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:BKENNY
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA MST
Authorized Official - Phone:570-823-6131
Mailing Address - Street 1:200 S MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6221
Mailing Address - Country:US
Mailing Address - Phone:570-823-6131
Mailing Address - Fax:570-823-5171
Practice Address - Street 1:80 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3035
Practice Address - Country:US
Practice Address - Phone:570-830-3905
Practice Address - Fax:570-826-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA600602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility