Provider Demographics
NPI:1386292035
Name:LACKAWANNA HEALTHCARE ASSOCIATES LLC
Entity type:Organization
Organization Name:LACKAWANNA HEALTHCARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINGERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-204-8787
Mailing Address - Street 1:1301 BLOOM RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-6532
Mailing Address - Country:US
Mailing Address - Phone:570-284-4343
Mailing Address - Fax:570-284-4346
Practice Address - Street 1:1301 BLOOM RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-6532
Practice Address - Country:US
Practice Address - Phone:570-284-4343
Practice Address - Fax:570-284-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03152020Medicaid