Provider Demographics
| NPI: | 1316075419 |
|---|---|
| Name: | ST. JOSEPH'S CENTER |
| Entity type: | Organization |
| Organization Name: | ST. JOSEPH'S CENTER |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VICE PRESIDENT CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROBERT |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GORDON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 570-963-1273 |
| Mailing Address - Street 1: | 2010 ADAMS AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SCRANTON |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 18509-1508 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 570-342-8379 |
| Mailing Address - Fax: | 570-963-1286 |
| Practice Address - Street 1: | 2010 ADAMS AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | SCRANTON |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 18509-1508 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 570-342-8379 |
| Practice Address - Fax: | 570-963-1286 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-03-01 |
| Last Update Date: | 2008-06-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 251C00000X | ||
| PA | 225100000X, 225800000X, 225A00000X, 225X00000X, 235Z00000X, 251E00000X, 320900000X, 385HR2060X, 315P00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | Group - Multi-Specialty | |
| No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 1000013880031 | Medicaid | |
| PA | 1000013880061 | Medicaid | |
| PA | 1000013880038 | Medicaid | |
| PA | 1000013880054 | Medicaid | |
| PA | 1000013880055 | Medicaid | |
| PA | 1576764PT | Other | HIGHMARK BLUE SHIELD |
| PA | 1000013880034 | Medicaid | |
| PA | 1000013880040 | Medicaid | |
| PA | 1000013880046 | Medicaid | |
| PA | 1000013880047 | Medicaid | |
| PA | 1000013880048 | Medicaid | |
| PA | 1576770ST | Other | HIGHMARK BLUE SHIELD |
| PA | 1000013880001 | Medicaid | |
| PA | 1000013880049 | Medicaid | |
| PA | 1000013880050 | Medicaid | |
| PA | 1000013880056 | Medicaid | |
| PA | 1000013880058 | Medicaid | |
| PA | 1000013880063 | Medicaid | |
| PA | 1000013880057 | Medicaid | |
| PA | 1000013880059 | Medicaid | |
| PA | 1000013880001 | Medicaid |
