Provider Demographics
NPI:1386124931
Name:SLATE BELT HOME CARE, LLC
Entity type:Organization
Organization Name:SLATE BELT HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-897-7900
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343
Mailing Address - Country:US
Mailing Address - Phone:570-897-7900
Mailing Address - Fax:570-897-7901
Practice Address - Street 1:1597 S. DELAWARE DRIVE, SUITE 2
Practice Address - Street 2:
Practice Address - City:MT BETHEL
Practice Address - State:PA
Practice Address - Zip Code:18343
Practice Address - Country:US
Practice Address - Phone:570-897-7900
Practice Address - Fax:570-897-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA19583601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001715098-0003Medicaid